Basic Information
| Provider Information | |||||||||
| NPI: | 1831174598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOWDHURY | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 E PALATINE RD | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600745551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477761400 | ||||||||
| FaxNumber: | 8477761424 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 E PALATINE RD | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600745551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477761400 | ||||||||
| FaxNumber: | 8477761424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD48064 | IA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 174400000X | 036105337 | IL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 250012754 | 01 | IL | MEDICARE RAILROAD | OTHER | 036105337 | 05 | IL | MEDICAID | 06168781 | 01 | IL | BC/BS | OTHER |