Healthcare Provider Details

I. General information

NPI: 1811126493
Provider Name (Legal Business Name): ASMA RAHMAN GHAFOOR M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2009
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL # 20NW
DAYTON OH
45417-3445
US

IV. Provider business mailing address

150 FOREST AVE UNIT 1404
OAK PARK IL
60301-1457
US

V. Phone/Fax

Practice location:
  • Phone: 937-280-4970
  • Fax:
Mailing address:
  • Phone: 630-200-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036139095
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036139095
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: