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General NPI Number Information
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NPI Number | 1124902242
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Entity Type | Individual
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Provider Name | MAIRA AHMAD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 3425 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60616-4108
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Country | US
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Telephone | 312-313-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 233 E WACKER DR APT 4201
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City | CHICAGO
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State | IL
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Zip | 60601-5116
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Country | US
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Telephone | 848-260-8340
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.036093
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License Number State | IL
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