MEDICARE: DR.IMTIAZ AHMED,PC

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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1225202617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.IMTIAZ AHMED,PC

Provider Business Mailing Address
First Line	:	4807 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3640
Country	:	US
Telephone Number	:	773-921-1103
Fax Number	:	773-261-1013

Provider Business Practice Location Address
First Line	:	4807 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3640
Country	:	US
Telephone Number	:	773-921-1103
Fax Number	:	773-261-1013

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMED SHARAFATULLAH SAYEED
Credential	:	DDS
Telephone Number	:	773-921-1103

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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