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General NPI Number Information
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NPI Number | 1720203086
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Entity Type | Organization
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Legal Business Name | DR TANVEER AHMAD PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 335 BLAKELY ST SUITE A
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City | WOODSTOCK
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State | IL
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Zip | 60098-3713
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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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Provider Business Mailing Address
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Address Line | 335 BLAKELY ST SUITE A
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City | WOODSTOCK
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State | IL
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Zip | 60098-3713
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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 | OWNER
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Name | DR. TANVEER AHMAD
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Credential | MD
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Telephone | 815-338-0900
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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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