| Mohammed I Ahmed Service Corporation | |
|
2803 W Harrison St Chicago IL 60612-3332 | |
| (773) 533-5523 | |
| (773) 533-1479 |
| Full Name | Mohammed I Ahmed Service Corporation |
|---|---|
| Speciality | General Practice |
| Location | 2803 W Harrison St, Chicago, Illinois |
| Authorized Official Name and Position | Mohammed Ismail Ahmed (OWNER) |
| Authorized Official Contact | 7735335523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mohammed I Ahmed Service Corporation 737 S Fairfield Ave Lombard IL 60148-3503 Ph: (773) 533-5523 | Mohammed I Ahmed Service Corporation 2803 W Harrison St Chicago IL 60612-3332 Ph: (773) 533-5523 |
| NPI Number | 1467765891 |
|---|---|
| Provider Enumeration Date | 07/14/2010 |
| Last Update Date | 03/11/2024 |
| Medicare PECOS PAC ID | 8022204841 |
|---|---|
| Medicare Enrollment ID | O20101118001279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467765891 | NPI | - | NPPES |
| 036081126 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 036081126 (Illinois) | Primary |
| Provider Name | Mohammed I Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427035500 PECOS PAC ID: 0446446264 Enrollment ID: I20101119000237 |
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