Healthcare Provider Details

I. General information

NPI: 1841371648
Provider Name (Legal Business Name): AHMAD O RASLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E BRUSH HILL RD STE 310
ELMHURST IL
60126-5662
US

IV. Provider business mailing address

4201 WINFIELD RD FL 4
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9003
  • Fax: 331-221-2743
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01057301A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01057301A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01057301A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-101274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: