1417933946 NPI number — MUKESH K AHLUWALIA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417933946 NPI number — MUKESH K AHLUWALIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHLUWALIA
Provider First Name:
MUKESH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417933946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E GOLF RD STE 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-8821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-376-8969
Provider Business Mailing Address Fax Number:
773-283-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3155 E SOUTHERN AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-5521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-655-8040
Provider Business Practice Location Address Fax Number:
480-655-1640
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  51506 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 036.080282 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 51506 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 51506 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036089624 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213339 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".