Healthcare Provider Details

I. General information

NPI: 1962403998
Provider Name (Legal Business Name): AZIZ AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E ARMY TRAIL RD SUITE 417
BLOOMINGDALE IL
60108-2169
US

IV. Provider business mailing address

303 E ARMY TRAIL RD SUITE 417
BLOOMINGDALE IL
60108-2169
US

V. Phone/Fax

Practice location:
  • Phone: 630-532-8999
  • Fax: 224-653-9645
Mailing address:
  • Phone: 630-532-8999
  • Fax: 224-653-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-087491
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036-087491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: