MEDICARE: DR. ASHRAF AHMAD D.D.S

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	1223G0001X	General Practice Dentistry	019026287	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1558350793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHRAF AHMAD D.D.S

Provider Business Mailing Address
First Line	:	3916 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2709
Country	:	US
Telephone Number	:	773-283-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3916 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2709
Country	:	US
Telephone Number	:	773-283-3513
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/14/2007

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