MEDICARE: ASHLAND MEDICAL SPECIALIST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	036103729	IL

General Provider Information

NPI Number	:	1033455118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLAND MEDICAL SPECIALIST INC

Provider Business Mailing Address
First Line	:	2041 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8521
Country	:	US
Telephone Number	:	312-624-9783
Fax Number	:	312-929-3323

Provider Business Practice Location Address
First Line	:	2041 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8521
Country	:	US
Telephone Number	:	312-624-9783
Fax Number	:	312-929-3323

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. NEEMA BAYRAN
Credential	:	M.D.
Telephone Number	:	312-624-9783

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	06/10/2025

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Directions to “ASHLAND MEDICAL SPECIALIST INC ” Practice Location

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