MEDICARE: DR. ALIA MUSHTAQ AHMED DDS

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	122300000X	Dentist	019.029109	IL

General Provider Information

NPI Number	:	1568727766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIA MUSHTAQ AHMED DDS

Provider Business Mailing Address
First Line	:	1037 W WELLINGTON AVE
Second Line	:	APT # 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-4377
Country	:	US
Telephone Number	:	703-850-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 W WELLINGTON AVE
Second Line	:	APT # 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-4377
Country	:	US
Telephone Number	:	703-850-9623
Fax Number	:

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

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	09/27/2015

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