Basic Information
| Provider Information | |||||||||
| NPI: | 1326103540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINHAJ | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | DEPT. OF ANESTHESIOLOGY | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702760 | ||||||||
| FaxNumber: | 8475702921 | ||||||||
| Practice Location | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | DEPT. OF ANESTHESIOLOGY | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702760 | ||||||||
| FaxNumber: | 8475702921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD60211740 | WA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 036109988 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0281175 | 01 | WA | L&I | OTHER | 1326103540 | 05 | WA | MEDICAID |