Provider Demographics
NPI:1154685089
Name:MOHIUDDIN, MOHD NOMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHD
Middle Name:NOMAN
Last Name:MOHIUDDIN
Suffix:
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 1:693 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1752
Mailing Address - Country:US
Mailing Address - Phone:630-326-8766
Mailing Address - Fax:630-326-8768
Practice Address - Street 1:693 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1752
Practice Address - Country:US
Practice Address - Phone:630-362-1562
Practice Address - Fax:630-326-8768
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130425207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130425OtherILLINOIS STATE LICENSE NUMBER