Healthcare Provider Details

I. General information

NPI: 1447446521
Provider Name (Legal Business Name): WAKAS AHMAD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

2323 NAPER VL RD STE 180
NAPERVILLE IL
60563-3541
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax: 630-358-6772
Mailing address:
  • Phone: 630-447-0312
  • Fax: 630-358-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.118128
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.118128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: