Basic Information
| Provider Information | |||||||||
| NPI: | 1053043885 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHUJA BARIATRIC & BEYOND | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 675 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628640014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4230 LINCOLNSHIRE DR STE A | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183156466 | ||||||||
| FaxNumber: | 6183156469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | AHUJA | ||||||||
| AuthorizedOfficialFirstName: | NARESH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6182422317 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.