Provider Demographics
NPI:1417933946
Name:AHLUWALIA, MUKESH K (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:K
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 E GOLF RD STE 211
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8821
Mailing Address - Country:US
Mailing Address - Phone:847-376-8969
Mailing Address - Fax:773-283-8688
Practice Address - Street 1:3155 E SOUTHERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5521
Practice Address - Country:US
Practice Address - Phone:480-655-8040
Practice Address - Fax:480-655-1640
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51506207RC0200X, 207RS0012X, 207RP1001X
IL036.080282207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089624Medicaid
AZ213339Medicaid
AZZ196368Medicare PIN
IL036089624Medicaid
AZ213339Medicaid