Healthcare Provider Details

I. General information

NPI: 1568443083
Provider Name (Legal Business Name): ASHRAF JEHAN AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 W DEVON AVE
CHICAGO IL
60660-1130
US

IV. Provider business mailing address

6702 FIELDSTONE DR
BURR RIDGE IL
60527-5297
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-4060
  • Fax:
Mailing address:
  • Phone: 630-986-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: