MEDICARE: AFMC VENDOR SERVICES LLC

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
1	207RN0300X	Nephrology Physician
2	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1336956200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFMC VENDOR SERVICES LLC

Provider Business Mailing Address
First Line	:	1131 S ARLINGTON HEIGHTS RD STE C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 S ARLINGTON HEIGHTS RD STE C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3140
Country	:	US
Telephone Number	:	630-782-9780
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MOHAMMAD VASEEMUDDIN
Credential	:
Telephone Number	:	847-323-5491

Provider Enumeration Date	:	12/14/2024
Last Update Date	:	06/11/2025

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