Individual provider · NPI-1

Mansoor Ahmad, M.D

Internal Medicine, Cardiovascular Disease · Peoria, IL

NPI number1194059600
StatusActive
Last updated in NPPESFeb 22, 2024

Details

NPI
1194059600
Entity type
Individual (NPI-1)
Name
Mansoor Ahmad
Credential
M.D
Sex
Male
Sole proprietor
No
Enumeration date
Sep 30, 2009
Certification date
Feb 22, 2024
Last updated
Feb 22, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RC0000X Internal Medicine, Cardiovascular Disease036.128536ILYes
207R00000X Internal Medicine125055157IL

Practice location

112 Ne Crescent Ave
Peoria, IL 61606-1901

Phone 309-672-4670 · Fax 309-672-4669

Mailing address

112 Ne Crescent Ave
Peoria, IL 61606-1901

Phone 309-672-4670 · Fax 309-672-4669

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