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General NPI Number Information
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NPI Number | 1649567231
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Entity Type | Organization
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Legal Business Name | FAZAL AHMED MD PC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 2340 S HIGHLAND AVE SUITE 370
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City | LOMBARD
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State | IL
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Zip | 60148-5371
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Country | US
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Telephone | 630-519-3092
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 S HIGHLAND AVE SUITE 370
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City | LOMBARD
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State | IL
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Zip | 60148-5371
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Country | US
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Telephone | 630-873-5425
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FAZAL AHMED
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Credential |
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Telephone | 630-674-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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