Individual
DR. MOHAMMED SHUJAUDDIN AHMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
396 REMINGTON BLVD STE 140, BOLINGBROOK, IL 60440-4311
(630) 495-9356
(630) 495-9357
Mailing address
120 W 22ND ST STE 200, OAK BROOK, IL 60523-1563
(630) 575-5000
(630) 491-5472
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-113939
IL
207RN0300X
Nephrology Physician
Primary
036113939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113939
—
IL
01
—
400280
MEDICARE GROUP PTAN
IL
Enumeration date
10/31/2006
Last updated
10/22/2020
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