Healthcare Provider Details

I. General information

NPI: 1154588317
Provider Name (Legal Business Name): ANIS AHMAD, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 7TH ST STE A
MOLINE IL
61265-5903
US

IV. Provider business mailing address

3061 7TH ST STE A
MOLINE IL
61265-5903
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-6161
  • Fax: 309-762-5387
Mailing address:
  • Phone: 309-762-6161
  • Fax: 309-762-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036049910
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036049910
License Number StateIL

VIII. Authorized Official

Name: ANIS AHMAD
Title or Position: M.D
Credential: M.D., F.R.C.P.
Phone: 309-762-6161