Healthcare Provider Details

I. General information

NPI: 1841240322
Provider Name (Legal Business Name): MOHAMMED NADEEM AHMED MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S LINCOLN AVE
URBANA IL
61801-4703
US

IV. Provider business mailing address

2504 WATERVILLE DR
CHAMPAIGN IL
61822-7416
US

V. Phone/Fax

Practice location:
  • Phone: 217-333-2700
  • Fax:
Mailing address:
  • Phone: 217-418-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036114258
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: