Healthcare Provider Details

I. General information

NPI: 1053043885
Provider Name (Legal Business Name): AHUJA BARIATRIC & BEYOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 LINCOLNSHIRE DR STE A
MOUNT VERNON IL
62864-2189
US

IV. Provider business mailing address

PO BOX 675
MOUNT VERNON IL
62864-0014
US

V. Phone/Fax

Practice location:
  • Phone: 618-315-6466
  • Fax: 618-315-6469
Mailing address:
  • Phone: 618-242-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NARESH AHUJA
Title or Position: MEMBER
Credential: MD
Phone: 618-242-2317