MEDICARE: DR. AZEEM MOHSIN AHSAN DO

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14DO713656	OTHER		CLIA

General Provider Information

NPI Number	:	1861543985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZEEM MOHSIN AHSAN DO

Provider Business Mailing Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	SUITE 100
City	:	CREST HILL
State	:	IL
Zip	:	60435-0959
Country	:	US
Telephone Number	:	815-741-2525
Fax Number	:	815-741-2522

Provider Business Practice Location Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	SUITE 100
City	:	CREST HILL
State	:	IL
Zip	:	60435-0959
Country	:	US
Telephone Number	:	815-741-2525
Fax Number	:	815-741-2522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	01/09/2008

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