Healthcare Provider Details

I. General information

NPI: 1326972563
Provider Name (Legal Business Name): IHMUD IHMUD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 W LANE RD
MACHESNEY PK IL
61115-1903
US

IV. Provider business mailing address

2745 N MULLIGAN AVE
CHICAGO IL
60639-1027
US

V. Phone/Fax

Practice location:
  • Phone: 815-749-9660
  • Fax:
Mailing address:
  • Phone: 312-532-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: