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General NPI Number Information
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NPI Number | 1093811374
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Entity Type | Individual
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Provider Name | TANVEER AHMAD MD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 21807 W GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-2944
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Country | US
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Telephone | 815-568-1074
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Fax | 815-568-0134
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Provider Business Mailing Address
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Address Line | PO BOX 1527
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City | WOODSTOCK
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State | IL
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Zip | 60098-1527
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Country | US
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Telephone | 815-338-0900
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Fax | 815-338-5390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036072630
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License Number State | IL
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