MEDICARE: DR. AHMID DREDAR 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	207Q00000X	Family Medicine Physician	A125375	CA
2	207Q00000X	Family Medicine Physician	036.161221	IL

General Provider Information

NPI Number	:	1174834931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMID DREDAR MD

Provider Business Mailing Address
First Line	:	2722 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1308
Country	:	US
Telephone Number	:	312-698-9040
Fax Number	:	855-618-2276

Provider Business Practice Location Address
First Line	:	2722 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1308
Country	:	US
Telephone Number	:	312-698-9040
Fax Number	:	855-618-2276

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

Provider Enumeration Date	:	06/27/2010
Last Update Date	:	08/11/2022

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Directions to “ DR. AHMID DREDAR MD” Practice Location

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