Provider Demographics
NPI:1457099459
Name:AHSAN, MOHAMMED X
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AHSAN
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 63 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2036
Mailing Address - Country:US
Mailing Address - Phone:773-216-2786
Mailing Address - Fax:
Practice Address - Street 1:732 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4058
Practice Address - Country:US
Practice Address - Phone:773-216-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach