MEDICARE: DR. NIDA-E-HAQUE MAHMUD DDS

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	1223P0221X	Pediatric Dentistry	021.003472	IL

General Provider Information

NPI Number	:	1992496392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDA-E-HAQUE MAHMUD DDS

Provider Business Mailing Address
First Line	:	465 N PARK DR APT 2807
Second Line	:	APT 2807
City	:	CHICAGO
State	:	IL
Zip	:	60611-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2062 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4002
Country	:	US
Telephone Number	:	773-384-3500
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	01/20/2026

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