Healthcare Provider Details

I. General information

NPI: 1306811948
Provider Name (Legal Business Name): ANJUM MUJAHID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANJUM MUJAHID M.D

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

IV. Provider business mailing address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax: 847-441-7968
Mailing address:
  • Phone: 609-716-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036156571
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number25MA08149100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: