Provider Demographics
NPI:1821134495
Name:AHMED, MAKIN UDDIN (MD)
Entity Type:Individual
Prefix:MR
First Name:MAKIN
Middle Name:UDDIN
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 W MAIN ST
Mailing Address - Street 2:STE # 1
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-346-2241
Mailing Address - Fax:618-346-4013
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:STE # 1
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:618-346-2241
Practice Address - Fax:618-346-4013
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine