Healthcare Provider Details

I. General information

NPI: 1033031224
Provider Name (Legal Business Name): MANAR AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LA GRANGE RD
LA GRANGE PARK IL
60526-5622
US

IV. Provider business mailing address

6836 WINSTON DR
TINLEY PARK IL
60477-1772
US

V. Phone/Fax

Practice location:
  • Phone: 708-745-5277
  • Fax:
Mailing address:
  • Phone: 708-928-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037370
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: