Healthcare Provider Details

I. General information

NPI: 1154372068
Provider Name (Legal Business Name): AMINA AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST STE 4-420
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST STE 4-420
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-472-4784
Mailing address:
  • Phone: 312-695-0990
  • Fax: 312-472-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036119719
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number36243
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36243
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: