Healthcare Provider Details

I. General information

NPI: 1154543916
Provider Name (Legal Business Name): FAISEL AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W DEYOUNG ST
MARION IL
62959-4437
US

IV. Provider business mailing address

1200 W DEYOUNG ST
MARION IL
62959-4437
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-5686
  • Fax: 618-997-6250
Mailing address:
  • Phone: 618-993-5686
  • Fax: 618-997-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2011002933
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.126730
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125-051104
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036126730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: