Provider Demographics
NPI:1164422515
Name:AHMAD, MAHER K (MD)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:K
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3865
Mailing Address - Country:US
Mailing Address - Phone:217-954-0119
Mailing Address - Fax:217-954-1698
Practice Address - Street 1:407 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3865
Practice Address - Country:US
Practice Address - Phone:217-954-0119
Practice Address - Fax:217-954-1698
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091950207R00000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091950Medicaid
ILG21535Medicare UPIN
IL209773Medicare ID - Type Unspecified