Provider Demographics
NPI:1730270406
Name:MOHIUDDIN, ANWAR M (MD)
Entity type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:M
Last Name:MOHIUDDIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:1251 E RICHTON RD
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1623
Practice Address - Country:US
Practice Address - Phone:708-672-6700
Practice Address - Fax:708-367-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036079439208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01369784OtherRR MEDICARE
IL036079439Medicaid
IL036079439OtherLICENSE NO
ILF400161726,61729,617Medicare PIN