Individual
MOHAMED ADENWALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
133 E BRUSH HILL RD STE 300, ELMHURST, IL 60126-5659
(630) 571-1501
(630) 571-5679
Mailing address
133 E BRUSH HILL RD STE 300, ELMHURST, IL 60126-5659
(630) 571-1501
(630) 571-5679
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-110825
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
036.110825
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110825
—
IL
01
—
2201714
BCBS OF IL
IL
01
—
P00366944
RR MEDICARE PIN
IL
Enumeration date
05/24/2006
Last updated
12/07/2021
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