Provider Demographics
NPI:1427035500
Name:AHMED, MOHAMMED I (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:I
Last Name:AHMED
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 1:737 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3503
Mailing Address - Country:US
Mailing Address - Phone:630-627-7909
Mailing Address - Fax:773-533-1479
Practice Address - Street 1:2803 W HARRISON ST
Practice Address - Street 2:HARRISON MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3332
Practice Address - Country:US
Practice Address - Phone:773-533-5523
Practice Address - Fax:773-533-1479
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031604609OtherBCBS
IL036081126Medicaid
IL970800Medicare ID - Type Unspecified
IL0031604609OtherBCBS