Provider Demographics
NPI:1619223716
Name:MOHIUDDIN, MOHAMMAD I I (RSA,CSA)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:I
Last Name:MOHIUDDIN
Suffix:I
Gender:M
Credentials:RSA,CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WESTMORE MEYERS RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3041
Mailing Address - Country:US
Mailing Address - Phone:630-935-2118
Mailing Address - Fax:
Practice Address - Street 1:208 WESTMORE MEYERS RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3041
Practice Address - Country:US
Practice Address - Phone:630-935-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000180363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical