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NPI Code Detail

MEDICARE: DR. AHMED TAREK ELRAKHAWY M.D.

MEDICARE: DR. AHMED TAREK ELRAKHAWY M.D.
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
1207R00000XInternal Medicine Physician036107788IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110244768OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3510814OTHERILHEALTHLINK

General Provider Information

NPI Number : 1306838503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AHMED TAREK ELRAKHAWY M.D.
Provider Business Mailing Address
First Line : 611 W PARK ST
Second Line : FAPC
City : URBANA
State : IL
Zip : 61801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1818 E WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-9566
Country : US
Telephone Number : 217-255-9646
Fax Number : 217-326-1777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 01/29/2021

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