Provider Demographics
NPI:1013174598
Name:AHUJA, NARESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:NARESH
Middle Name:KUMAR
Last Name:AHUJA
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:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0014
Mailing Address - Country:US
Mailing Address - Phone:618-315-6466
Mailing Address - Fax:618-315-6469
Practice Address - Street 1:4230 LINCOLNSHIRE DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-315-6466
Practice Address - Fax:618-315-6469
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434356208600000X
390200000X
IL036124910208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL721089OtherAETNA
IL3932056OtherBCBS
IL036124910Medicaid
IL3932056OtherBCBS
IL214881Medicare Oscar/Certification
PA128497FKYMedicare PIN