Provider Demographics
NPI:1548292683
Name:MOINUDDIN, AKIL II (MD)
Entity type:Individual
Prefix:
First Name:AKIL
Middle Name:
Last Name:MOINUDDIN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3424
Mailing Address - Country:US
Mailing Address - Phone:630-844-0080
Mailing Address - Fax:630-801-6967
Practice Address - Street 1:302 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3424
Practice Address - Country:US
Practice Address - Phone:630-844-0080
Practice Address - Fax:630-801-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086879Medicaid
IL110075398OtherRAILROAD MEDICARE
IL14D0940581OtherCLIA
IL10592526OtherCAQH
IL10592526OtherCAQH
IL10592526OtherCAQH
IL036086879Medicaid