Healthcare Provider Details

I. General information

NPI: 1164189585
Provider Name (Legal Business Name): AHMED ALNASHRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

901 S ASHLAND AVE APT 1211
CHICAGO IL
60607-4093
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone: 312-776-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.078855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: