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NPI Code Detail

MEDICARE: MOHAMMED J MOHIUDDIN M.D.

MEDICARE: MOHAMMED J MOHIUDDIN M.D.
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
1207L00000XAnesthesiology Physician43730020WI
2207L00000XAnesthesiology Physician036.142717IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
212952OTHERWIDEANCARE HMO

General Provider Information

NPI Number : 1417945379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAMMED J MOHIUDDIN M.D.
Provider Business Mailing Address
First Line : 2202 HARLEM ROAD
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Provider Business Practice Location Address
First Line : 2202 HARLEM ROAD
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 07/28/2025

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