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General NPI Number Information
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NPI Number | 1518166461
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Entity Type | Individual
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Provider Name | MOHTASHAM MUHAMMED MOHIUDDIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6224 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60636-2324
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Country | US
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Telephone | 718-440-1826
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 WARREN ST UNIT 607
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City | SKOKIE
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State | IL
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Zip | 60077-2986
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Country | US
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Telephone | 718-440-1726
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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 | 244888
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301091423
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License Number State | MI
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