Provider Demographics
NPI:1508889023
Name:AHSAN, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:AHSAN
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 1:880 W CENTRAL RD
Mailing Address - Street 2:STE 3800
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2369
Mailing Address - Country:US
Mailing Address - Phone:847-255-0900
Mailing Address - Fax:847-255-4344
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:STE 880
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-255-0900
Practice Address - Fax:847-255-4344
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102219207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102219Medicaid
ILL80590Medicare PIN
ILK45460Medicare PIN
IL036102219Medicaid