Provider Demographics
NPI:1467765891
Name:MOHAMMED I AHMED SERVICE CORPORATION
Entity Type:Organization
Organization Name:MOHAMMED I AHMED SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-533-5523
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:773-533-5523
Mailing Address - Fax:773-533-1479
Practice Address - Street 1:2803 W HARRISON ST
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081126Medicaid
IL970800Medicare PIN
IL036081126Medicaid