Provider Demographics
NPI:1174511661
Name:AHMAD, ANIS (MD, FRCP)
Entity Type:Individual
Prefix:DR
First Name:ANIS
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD, FRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 7TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5925
Mailing Address - Country:US
Mailing Address - Phone:309-762-6161
Mailing Address - Fax:309-762-5387
Practice Address - Street 1:3061 7TH ST
Practice Address - Street 2:STE A
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5925
Practice Address - Country:US
Practice Address - Phone:309-762-6161
Practice Address - Fax:309-762-5387
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049910Medicaid
IL036049910Medicaid
IL263251Medicare PIN