Healthcare Provider Details

I. General information

NPI: 1871161430
Provider Name (Legal Business Name): AKIF AHMED DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST
DECATUR IL
62526-4192
US

IV. Provider business mailing address

2300 N EDWARD ST
DECATUR IL
62526-4192
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3660
  • Fax: 217-876-3665
Mailing address:
  • Phone: 217-876-3660
  • Fax: 217-876-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036170805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: