Provider Demographics
NPI:1659375343
Name:CHEEMA, CHAUDRY AHMAD WAHEED (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAUDRY AHMAD
Middle Name:WAHEED
Last Name:CHEEMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AHMAD
Other - Middle Name:WAHEED
Other - Last Name:CHEEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2570 24TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-4800
Mailing Address - Fax:309-779-4805
Practice Address - Street 1:2570 24TH ST STE 121
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-4800
Practice Address - Fax:309-779-4805
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-03-11
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IA35024207RG0100X
IL036102620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00037258OtherRAILROAD MEDICARE
IA0290791Medicaid
IL$$$$$$$$$001Medicaid
ILL98315Medicare ID - Type Unspecified