Provider Demographics
NPI:1427042985
Name:QURESHI, MUHAMMAD MUSTANSAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:MUSTANSAR
Last Name:QURESHI
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 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:441 W HAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6324
Practice Address - Country:US
Practice Address - Phone:217-876-6860
Practice Address - Fax:217-876-6868
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056955A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN796270GGMedicare ID - Type Unspecified
H78448Medicare UPIN
IN200424300Medicaid