Provider Demographics
NPI:1467146456
Name:MAHMUD, AYHAM
Entity Type:Individual
Prefix:
First Name:AYHAM
Middle Name:
Last Name:MAHMUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 KEENEY ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3551
Mailing Address - Country:US
Mailing Address - Phone:847-809-7909
Mailing Address - Fax:
Practice Address - Street 1:5808 KEENEY ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3551
Practice Address - Country:US
Practice Address - Phone:847-809-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician