Provider Demographics
NPI:1871611582
Name:MOHSIN, MAHMUDA SULTANA (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMUDA
Middle Name:SULTANA
Last Name:MOHSIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MACINTOSH CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6478
Mailing Address - Country:US
Mailing Address - Phone:630-858-0460
Mailing Address - Fax:
Practice Address - Street 1:173 MACINTOSH CT
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6478
Practice Address - Country:US
Practice Address - Phone:630-858-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03605446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13157Medicare UPIN