Mutasem Ali Ahmad
Individual provider Active NPI Pharmacist · Braidwood, IL
NPI 1194644526 · NPPES record last updated Jul 10, 2026
Key facts
- NPI
- 1194644526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051308773 (IL)
- Practice address
- 230 S Comet Dr
Braidwood, IL 60408-2028 - Phone
- (815) 458-0642
- NPI assigned
- Jul 10, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 051308773 | IL | Yes |
Addresses
Primary practice location
230 S Comet Dr
Braidwood, IL 60408-2028
Mailing address
7400 W 58TH St
Summit, IL 60501-1350
Phone (708) 712-6203
Other providers in Braidwood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.