Healthcare Provider Details

I. General information

NPI: 1326103540
Provider Name (Legal Business Name): MOHAMMED M MINHAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/16/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. DEPT. OF ANESTHESIOLOGY
EVANSTON IL
60201
US

IV. Provider business mailing address

2650 RIDGE AVE. DEPT. OF ANESTHESIOLOGY
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2760
  • Fax: 847-570-2921
Mailing address:
  • Phone: 847-570-2760
  • Fax: 847-570-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60211740
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036109988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: