Healthcare Provider Details

I. General information

NPI: 1275572331
Provider Name (Legal Business Name): AAKASH B AHUJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE SUITE 402
MELROSE PARK IL
60160-1634
US

IV. Provider business mailing address

655 DEERFIELD RD SUITE 100 PMB 418
DEERFIELD IL
60015-3241
US

V. Phone/Fax

Practice location:
  • Phone: 708-667-4333
  • Fax: 708-667-4334
Mailing address:
  • Phone: 708-667-4333
  • Fax: 708-667-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.087026
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00023747
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0116010494
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: