Healthcare Provider Details

I. General information

NPI: 1861425720
Provider Name (Legal Business Name): AHMAD AMMAR MOURAD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 N ALPINE RD
ROCKFORD IL
61107-2201
US

IV. Provider business mailing address

1253 N ALPINE RD
ROCKFORD IL
61107-2201
US

V. Phone/Fax

Practice location:
  • Phone: 815-713-6995
  • Fax:
Mailing address:
  • Phone: 815-713-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036-121773
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: