Healthcare Provider Details

I. General information

NPI: 1861988222
Provider Name (Legal Business Name): AHMAD MARWAN NASSAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST STE 820-E
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST STE 820-E
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-9424
  • Fax: 312-413-4131
Mailing address:
  • Phone: 312-996-9424
  • Fax: 312-413-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number104596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: