Provider Demographics
NPI:1992966873
Name:AHMAD, KIRUN NASEEM (DO)
Entity type:Individual
Prefix:
First Name:KIRUN
Middle Name:NASEEM
Last Name:AHMAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1188
Mailing Address - Country:US
Mailing Address - Phone:618-246-2910
Mailing Address - Fax:618-246-2912
Practice Address - Street 1:2401 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1496
Practice Address - Country:US
Practice Address - Phone:618-246-2910
Practice Address - Fax:618-246-2912
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine