Active NPI
Mohammed Murtaza Ali Mir
- Dentist
- Villa Park, IL
National Provider Identifier
1205402625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.033098
- Practice address
- 144 W Roosevelt Rd
Villa Park, IL 60181-3504 - Phone
- (773) 548-0600
- NPI assigned
- May 27, 2021
- Last updated
- May 27, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.033098 | IL | Primary |
Addresses
Primary practice location
144 W Roosevelt Rd
Villa Park, IL 60181-3504
Mailing address
2005 S Meyers Rd Apt 220
Oakbrook Terrace, IL 60181-5268
Phone (646) 468-5033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033098 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622073600000",
"number": "1205402625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 S MEYERS RD APT 220",
"city": "OAKBROOK TERRACE",
"state": "IL",
"postal_code": "601815268",
"telephone_number": "646-468-5033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 W ROOSEVELT RD",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601813504",
"telephone_number": "773-548-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIR",
"first_name": "MOHAMMED MURTAZA",
"middle_name": "ALI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-27",
"last_updated": "2021-05-27",
"certification_date": "2021-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.033098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.