MEDICARE: FNU AYESHA 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	207R00000X	Internal Medicine Physician	036170176	IL

General Provider Information

NPI Number	:	1750953394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FNU AYESHA MD

Provider Business Mailing Address
First Line	:	600 E SIBLEY BLVD
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-2599
Country	:	US
Telephone Number	:	708-340-7400
Fax Number	:	708-340-7140

Provider Business Practice Location Address
First Line	:	600 E SIBLEY BLVD
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-2599
Country	:	US
Telephone Number	:	708-340-7400
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	05/22/2024

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Directions to “ FNU AYESHA MD” Practice Location

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