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General NPI Number Information
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NPI Number | 1336566538
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Entity Type | Individual
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Provider Name | THANZEELA KAUSAR MOHIDEEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 10215 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-8001
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Country | US
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Telephone | 219-661-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 BALLARD RD
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City | PARK RIDGE
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State | IL
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Zip | 60068-1005
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Country | US
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Telephone | 847-318-9340
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.064632
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 01080587A
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License Number State | IN
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