Healthcare Provider Details

I. General information

NPI: 1619521705
Provider Name (Legal Business Name): SAKIF AHMED FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CADENCE PARK PLZ STE 146
MICHIGAN CITY IN
46360-3332
US

IV. Provider business mailing address

1 CADENCE PARK PLZ STE 146
MICHIGAN CITY IN
46360-3332
US

V. Phone/Fax

Practice location:
  • Phone: 708-486-2700
  • Fax:
Mailing address:
  • Phone: 224-789-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019300
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.019300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: