Provider Demographics
NPI:1952453995
Name:VASEEMUDDIN, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:VASEEMUDDIN
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 1:1865 N NELTNOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5900
Mailing Address - Country:US
Mailing Address - Phone:224-777-8045
Mailing Address - Fax:847-789-9800
Practice Address - Street 1:1419 W LAKE ST STE A
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3930
Practice Address - Country:US
Practice Address - Phone:224-777-8045
Practice Address - Fax:224-236-4900
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine