Healthcare Provider Details

I. General information

NPI: 1609816875
Provider Name (Legal Business Name): FARIDA AHMED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OUR LADY OF THE RESURRECTION HOSPITAL 5645 W. ADDISON STREET
CHICAGO IL
60634
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-7000
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax: 630-874-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036066117
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number036066117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: