Basic Information
| Provider Information | |||||||||
| NPI: | 1952453995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASEEMUDDIN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1865 N NELTNOR BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WEST CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601855900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247778045 | ||||||||
| FaxNumber: | 8477899800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1419 W LAKE ST STE A | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601603930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247778045 | ||||||||
| FaxNumber: | 2242364900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 10/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-110447 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.