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General NPI Number Information
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NPI Number | 1316908965
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Entity Type | Organization
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Legal Business Name | AHMAD BASTANI MD
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6033 N SHERIDAN RD SUITE S-8
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City | CHICAGO
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State | IL
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Zip | 60660
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Country | US
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Telephone | 773-506-9600
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Fax | 773-506-9655
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Provider Business Mailing Address
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Address Line | 6033 N SHERIDAN RD SUITE S-8
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City | CHICAGO
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State | IL
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Zip | 60660
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Country | US
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Telephone | 773-506-9600
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Fax | 773-506-9655
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Authorized Official
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Title or Position | MD
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Name | AHMAD BASTANI
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Credential | MD
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Telephone | 773-506-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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