Basic Information
| Provider Information | |||||||||
| NPI: | 1992783377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHMOOD | ||||||||
| FirstName: | KAMRAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 S MICHIGAN AVE | ||||||||
| Address2: | B-390 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125676691 | ||||||||
| FaxNumber: | 3123287895 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 S MICHIGAN AVE | ||||||||
| Address2: | B-390 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125676691 | ||||||||
| FaxNumber: | 3123287895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 036107735 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 214137 | 01 | IL | MEDICARE-PRIVATE PRCTC | OTHER | 01636491 | 01 | IL | BLUE SHIELD-PRIVATE PRCTC | OTHER | 036107735 | 01 | IL | IL LICENSE | OTHER | 336068702 | 01 | IL | CSC | OTHER | BM8106127 | 01 | IL | IL DEA LICENSE | OTHER | 036107735-3 | 01 | IL | MEDICAID-PRIVATE PRCTC | OTHER |