Healthcare Provider Details

I. General information

NPI: 1184849747
Provider Name (Legal Business Name): TAREK MOHAMAD AHDAB MD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAMAD TAREK ALAHDAB M.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

IV. Provider business mailing address

29624 NETWORK PL
CHICAGO IL
60673-1296
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036105726
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036105726
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number036105726
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036105726
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036105726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: