Healthcare Provider Details

I. General information

NPI: 1356328058
Provider Name (Legal Business Name): SUSAN E AHMARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 SEVEN BRIDGES DR STE 230
WOODRIDGE IL
60517-1222
US

IV. Provider business mailing address

3540 SEVEN BRIDGES DR STE 230
WOODRIDGE IL
60517-1222
US

V. Phone/Fax

Practice location:
  • Phone: 630-964-9400
  • Fax: 630-964-9375
Mailing address:
  • Phone: 630-964-9400
  • Fax: 630-964-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number360101756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: