Healthcare Provider Details

I. General information

NPI: 1972667129
Provider Name (Legal Business Name): HUMA A AHMED CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 W ROOSEVELT RD SUITE #304
WESTCHESTER IL
60154-2664
US

IV. Provider business mailing address

10001 W ROOSEVELT RD SUITE #304
WESTCHESTER IL
60154-2664
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-4464
  • Fax: 708-344-6577
Mailing address:
  • Phone: 708-345-4464
  • Fax: 708-344-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: