Healthcare Provider Details

I. General information

NPI: 1306028147
Provider Name (Legal Business Name): AYESHA AKBAR, M. D ., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10181 W LINCOLN HWY
FRANKFORT IL
60423-1274
US

IV. Provider business mailing address

10181 W LINCOLN HWY
FRANKFORT IL
60423-1274
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-7212
  • Fax: 815-277-5509
Mailing address:
  • Phone: 815-464-7212
  • Fax: 815-277-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number036099651
License Number StateIL

VIII. Authorized Official

Name: NANCY SARASON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 815-464-7212