Healthcare Provider Details

I. General information

NPI: 1841585775
Provider Name (Legal Business Name): MUKESH K AHLUWALIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST SUITE 306
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

2123 WINCHESTER LN
GLENVIEW IL
60026-5749
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-8664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036080282
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036080282
License Number StateIL

VIII. Authorized Official

Name: MUKESH K AHLUWALIA
Title or Position: OWNER
Credential: M.D.
Phone: 773-283-8664