Provider Demographics
NPI:1851460380
Name:MUSHTAQ, MUHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:MUSHTAQ
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 1:707 N LOGAN AVE
Mailing Address - Street 2:DANVILLE POLYCLINIC, LTD.
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-431-1100
Mailing Address - Fax:217-431-2900
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:DANVILLE POLYCLINIC, LTD.
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-431-1100
Practice Address - Fax:217-431-2900
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047023207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0054830OtherCIGNA
IL036047023Medicaid
282980OtherHEALTH ALLIANCE
ILF400181920Medicare PIN
282980OtherHEALTH ALLIANCE
IL1851460380Medicare PIN