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General NPI Number Information
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NPI Number | 1942477658
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Entity Type | Individual
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Provider Name | MIR ASHAD ALI YADULLAHI M.D
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 1500 SOUTH CALIFORNIA AVENUE OS-551
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City | CHICAGO
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State | IL
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Zip | 60608-1782
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Country | US
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Telephone | 773-257-6552
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Fax |
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Provider Business Mailing Address
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Address Line | 441 DELAWARE CIR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1467
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Country | US
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Telephone | 630-414-8232
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036122477
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 036122477
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License Number State | IL
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