Provider Demographics
NPI:1922117811
Name:AHMED, MISBAHUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:MISBAHUDDIN
Middle Name:
Last Name:AHMED
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 1:1056 SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1670
Mailing Address - Country:US
Mailing Address - Phone:815-549-6551
Mailing Address - Fax:888-996-2325
Practice Address - Street 1:1056 SWIFT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1670
Practice Address - Country:US
Practice Address - Phone:815-549-6551
Practice Address - Fax:888-996-2325
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052209207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052209Medicaid
D14352Medicare UPIN
651320Medicare ID - Type Unspecified