MEDICARE: ASHIR WAHAB 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	036096993	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080188117	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1376591958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHIR WAHAB MD

Provider Business Mailing Address
First Line	:	PO BOX 639295 DEPT 93394
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9295
Country	:	US
Telephone Number	:	248-434-6169
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	19400 NORTH CREEK DRIVE
Second Line	:
City	:	LYNWOOD
State	:	IL
Zip	:	60411-8742
Country	:	US
Telephone Number	:	708-474-0410
Fax Number	:	708-474-0328

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/18/2022

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Directions to “ ASHIR WAHAB MD” Practice Location

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