Provider Demographics
NPI:1154588317
Name:ANIS AHMAD, M.D., S.C.
Entity type:Organization
Organization Name:ANIS AHMAD, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FRCP
Authorized Official - Phone:309-762-6161
Mailing Address - Street 1:3061 7TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5903
Mailing Address - Country:US
Mailing Address - Phone:309-762-6161
Mailing Address - Fax:309-762-5387
Practice Address - Street 1:3061 7TH ST
Practice Address - Street 2:STE A
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5903
Practice Address - Country:US
Practice Address - Phone:309-762-6161
Practice Address - Fax:309-762-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049910207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360499102Medicaid
IL111918028OtherRAILROAD MEDICARE PIN
IL263251Medicare PIN
ILD10439Medicare UPIN