Provider Demographics
NPI:1932285509
Name:EKBAL, MOEED (DPM)
Entity Type:Individual
Prefix:DR
First Name:MOEED
Middle Name:
Last Name:EKBAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N LAKEVIEW AVE APT 2703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2741
Mailing Address - Country:US
Mailing Address - Phone:773-383-8173
Mailing Address - Fax:
Practice Address - Street 1:2400 N LAKEVIEW AVE APT 2703
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2741
Practice Address - Country:US
Practice Address - Phone:773-383-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004994213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004994Medicaid
IL016004994Medicaid
IL016004994Medicaid