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General NPI Number Information
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NPI Number | 1972096642
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Entity Type | Individual
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Provider Name | ARSHAD ASIM MOHAMMED
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Gender | Male
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 4501 S STATE ST
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City | CHICAGO
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State | IL
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Zip | 60609-3758
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Country | US
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Telephone | 773-548-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 43 FOUNDERS POINTE N
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1459
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Country | US
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Telephone | 630-624-3792
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031601
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License Number State | IL
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