Provider Demographics
NPI:1679135735
Name:AJMERI, MOHITKUMAR SUNILKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MOHITKUMAR
Middle Name:SUNILKUMAR
Last Name:AJMERI
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 1:441 W HAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6325
Mailing Address - Country:US
Mailing Address - Phone:217-876-4810
Mailing Address - Fax:217-527-3412
Practice Address - Street 1:441 W HAY ST STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6325
Practice Address - Country:US
Practice Address - Phone:217-876-4810
Practice Address - Fax:217-527-3412
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036159113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine