Healthcare Provider Details

I. General information

NPI: 1033139092
Provider Name (Legal Business Name): MOYEED AKHTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 700
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE SUITE 700
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-2101
  • Fax: 773-784-0771
Mailing address:
  • Phone: 773-784-2101
  • Fax: 773-784-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: