Provider Demographics
NPI:1700828563
Name:MOHAMMED, MUSHTAQ HUSSAIN (MD)
Entity Type:Individual
Prefix:
First Name:MUSHTAQ
Middle Name:HUSSAIN
Last Name:MOHAMMED
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 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-312-7755
Mailing Address - Fax:
Practice Address - Street 1:1000 REMINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5114
Practice Address - Country:US
Practice Address - Phone:630-312-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114415207R00000X
IL036114415208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-114415Medicaid
ILT01625Medicare PIN
IL036-114415Medicaid
ILT01624Medicare PIN