MEDICARE: DR. ASHRAF JEHAN AHMED MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031601180	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1568443083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHRAF JEHAN AHMED MD

Provider Business Mailing Address
First Line	:	6702 FIELDSTONE DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5297
Country	:	US
Telephone Number	:	630-986-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1130
Country	:	US
Telephone Number	:	773-274-4060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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