Healthcare Provider Details

I. General information

NPI: 1063917946
Provider Name (Legal Business Name): IMRAN AKHTAR D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

18 KINGSTON DR
OAK BROOK IL
60523-1739
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax:
Mailing address:
  • Phone: 630-280-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036156805
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036156805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: