Healthcare Provider Details

I. General information

NPI: 1649652272
Provider Name (Legal Business Name): SADIA AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 S RT 83
MUNDELEIN IL
60060
US

IV. Provider business mailing address

718 SOUTH ROUTE 83
MUNDELEIN IL
60060
US

V. Phone/Fax

Practice location:
  • Phone: 224-351-8707
  • Fax:
Mailing address:
  • Phone: 224-351-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-030350
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: