Individual
MANSOOR AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
(309) 672-4669
Mailing address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
(309) 672-4669
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125055157
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036.128536
IL
Other
Enumeration date
09/30/2009
Last updated
02/22/2024
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