Individual
MICHAEL A AHEARN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
519 ELLIOTT ST, SUITE S1, KEWANEE, IL 61443-2796
(309) 853-2442
Mailing address
519 ELLIOTT ST, SUITE S1, KEWANEE, IL 61443-2796
(309) 853-2442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036074050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074050
—
IL
01
—
36074050
BCBS
IL
01
—
P00196862
RAILROAD MEDICARE
IL
Enumeration date
04/06/2006
Last updated
05/27/2020
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