MEDICARE: AHTESHAM HYDER 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	207R00000X	Internal Medicine Physician	036112807	IL
2	208M00000X	Hospitalist Physician	036112807	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	036112807	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1740207505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHTESHAM HYDER MD

Provider Business Mailing Address
First Line	:	515 22ND AVE
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1569
Country	:	US
Telephone Number	:	815-914-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W CENTRAL RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2349
Country	:	US
Telephone Number	:	815-914-1414
Fax Number	:	847-618-3259

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/01/2026

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