MEDICARE: DR. HARMEEN AHUJA PH.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	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001636284	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1407985930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARMEEN AHUJA PH.D.

Provider Business Mailing Address
First Line	:	655 W IRVING PARK RD
Second Line	:	#202
City	:	CHICAGO
State	:	IL
Zip	:	60613-3123
Country	:	US
Telephone Number	:	773-509-4911
Fax Number	:	773-279-1201

Provider Business Practice Location Address
First Line	:	4514 N SACRAMENTO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3830
Country	:	US
Telephone Number	:	773-509-4911
Fax Number	:	773-279-1201

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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