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NPI Code Detail

MEDICARE: MOHAMMED ALTAF KAISERUDDIN MD

MEDICARE: MOHAMMED ALTAF KAISERUDDIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036112300IL
2207P00000XEmergency Medicine Physician45398-020WI

General Provider Information

NPI Number : 1164455978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAMMED ALTAF KAISERUDDIN MD
Provider Business Mailing Address
First Line : 15628 CALYPSO LN
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-5114
Country : US
Telephone Number : 708-620-8040
Fax Number :
Provider Business Practice Location Address
First Line : 2744 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-2343
Country : US
Telephone Number : 773-434-4626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 09/08/2016

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