MEDICARE: KHANSA AHMAD 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
1	207RC0000X	Cardiovascular Disease Physician	1019208	MA

General Provider Information

NPI Number	:	1366837007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANSA AHMAD M.D

Provider Business Mailing Address
First Line	:	4440W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2600
Country	:	US
Telephone Number	:	708-684-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 N CLARENDON AVE APT 508
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5749
Country	:	US
Telephone Number	:	832-477-6443
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	02/18/2026

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