Provider Demographics
NPI:1780962506
Name:DIVERSIFIED MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:DIVERSIFIED MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-0678
Mailing Address - Street 1:5023 N ILLINOIS ST
Mailing Address - Street 2:STE 1
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3453
Mailing Address - Country:US
Mailing Address - Phone:618-239-0678
Mailing Address - Fax:800-516-2392
Practice Address - Street 1:5023 N ILLINOIS ST
Practice Address - Street 2:STE 1
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3453
Practice Address - Country:US
Practice Address - Phone:618-239-0678
Practice Address - Fax:800-516-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty