=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912997933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAVEED AKHTAR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 07/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 W BOUGHTON RD SUITE F-1
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-1872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-378-4014
-----------------------------------------------------
Fax | 630-378-4784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 KINGSBURY CT
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-920-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0201X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
-----------------------------------------------------
License Number | 036-077398
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------