Basic Information
| Provider Information | |||||||||
| NPI: | 1659592624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NADEEM | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 NORTH OAK ST | ||||||||
| Address2: | |||||||||
| City: | OFALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186243368 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 103 NORTH OAK ST | ||||||||
| Address2: | |||||||||
| City: | OFALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186243368 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PH0002X | 036117632 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Hospice and Palliative Medicine | 207P00000X | 036-117632 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036117632 | 01 | IL | LICENSE | OTHER |