Healthcare Provider Details

I. General information

NPI: 1003869553
Provider Name (Legal Business Name): MALEEHA A AHSAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

IV. Provider business mailing address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

V. Phone/Fax

Practice location:
  • Phone: 630-719-5454
  • Fax: 630-719-1263
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036089681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: