Provider Demographics
NPI:1487688131
Name:ANSARI, MOHAMMED JAVEED I (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED JAVEED
Middle Name:I
Last Name:ANSARI
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 1:300 E SUPERIOR ST
Mailing Address - Street 2:TARRY BLDG, SUITE 11-723
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3010
Mailing Address - Country:US
Mailing Address - Phone:312-503-2677
Mailing Address - Fax:312-503-3366
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER-17
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122680207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology