Healthcare Provider Details

I. General information

NPI: 1790280196
Provider Name (Legal Business Name): AHMAD JARRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W MEDICAL CENTER DR
MCHENRY IL
60050-8409
US

IV. Provider business mailing address

4201 W MEDICAL CENTER DR
MCHENRY IL
60050-8409
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-4530
  • Fax: 815-759-8053
Mailing address:
  • Phone: 815-759-4530
  • Fax: 815-759-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME150209
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number32344
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: