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General NPI Number Information
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NPI Number | 1467765891
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Entity Type | Organization
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Legal Business Name | MOHAMMED I AHMED SERVICE CORPORATION
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 2803 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3332
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Country | US
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Telephone | 773-533-5523
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Fax | 773-533-1479
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Provider Business Mailing Address
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Address Line | 737 S FAIRFIELD AVE
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City | LOMBARD
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State | IL
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Zip | 60148-3503
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Country | US
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Telephone | 773-533-5523
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Fax | 773-533-1479
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMED ISMAIL AHMED
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Credential | M.D.
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Telephone | 773-533-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036081126
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License Number State | IL
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