Provider Demographics
NPI:1043363211
Name:MAHMOOD, RANA HAMID (MD)
Entity type:Individual
Prefix:
First Name:RANA
Middle Name:HAMID
Last Name:MAHMOOD
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 1:1750 E LAKE SHORE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3806
Mailing Address - Country:US
Mailing Address - Phone:217-872-5943
Mailing Address - Fax:217-872-7665
Practice Address - Street 1:1750 E LAKE SHORE DR STE 310
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3806
Practice Address - Country:US
Practice Address - Phone:217-872-5943
Practice Address - Fax:217-872-7665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098559174400000X, 2084N0400X
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098559Medicaid
ILG83573Medicare UPIN
IL036098559Medicaid
IL036098559Medicaid
IL708020Medicare ID - Type Unspecified