Healthcare Provider Details

I. General information

NPI: 1750388476
Provider Name (Legal Business Name): AHMED ELBORNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6747 KINGERY HWY
WILLOWBROOK IL
60527-5142
US

IV. Provider business mailing address

PO BOX 3336
HINSDALE IL
60522-3336
US

V. Phone/Fax

Practice location:
  • Phone: 773-836-7246
  • Fax: 773-637-4229
Mailing address:
  • Phone: 630-245-1010
  • Fax: 630-245-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-095342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: