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General NPI Number Information
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NPI Number | 1043230857
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Entity Type | Individual
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Provider Name | MOHAMED DAHODWALA MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 6441 S PULASKI RD SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-284-1234
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Fax | 773-284-1811
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Provider Business Mailing Address
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Address Line | PO BOX 64568
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City | PHOENIX
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State | AZ
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Zip | 85082-4568
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Country | US
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Telephone | 630-288-6200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036065163
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License Number State | IL
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