Active NPI
Mohammed Khaleeluddin, MD
- Family Medicine Physician
- Rockford, IL
National Provider Identifier
1205976024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036087482
- Practice address
- 1729 Oak Park Drive
Rockford, IL 61107-5510 - Phone
- (815) 395-0632
- Fax
- (815) 395-0632
- NPI assigned
- Feb 8, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036087482 | IL | Primary |
Addresses
Primary practice location
1729 Oak Park Drive
Rockford, IL 61107-5510
Mailing address
1729 Oak Park Drive
Rockford, IL 61107-5510
Phone (815) 395-0632
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004132023 | Other | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036087482 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Franklin Harrison DO | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205976024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1729 OAK PARK DRIVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075510",
"telephone_number": "815-395-0632",
"fax_number": "815-395-0632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1729 OAK PARK DRIVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075510",
"telephone_number": "815-395-0632",
"fax_number": "815-395-0632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHALEELUDDIN",
"first_name": "MOHAMMED",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036087482",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0004132023",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.