MEDICARE: DR. AMJAD ALI SAFVI MD

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	2085R0202X	Diagnostic Radiology Physician	M-2215	GU
2	2085R0204X	Vascular & Interventional Radiology Physician	MD453599	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-099445	OTHER	IL	IL MEDICAL LICENSE
2	336-059832	OTHER	IL	IL PHARMACY NUMBER
3	1739	OTHER	IL	PTAN IL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093707457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMJAD ALI SAFVI MD

Provider Business Mailing Address
First Line	:	721 W IL ROUTE 22
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2552
Country	:	US
Telephone Number	:	708-827-5732
Fax Number	:	708-827-5742

Provider Business Practice Location Address
First Line	:	721 W STATE ROUTE 22
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2552
Country	:	US
Telephone Number	:	708-827-5732
Fax Number	:	708-827-5742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/06/2026

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