Healthcare Provider Details

I. General information

NPI: 1275962672
Provider Name (Legal Business Name): SAIRA RASHIDA AJMAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/24/2021
Certification Date: 12/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST STE 301
OAK LAWN IL
60453
US

IV. Provider business mailing address

4440 W 95TH ST STE 301
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1840
  • Fax:
Mailing address:
  • Phone: 708-684-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number59051
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN17477
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036.147041
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: