Individual
DR. MOIZ EHTESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036164899
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/04/2020
Last updated
05/31/2023
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