MEDICARE: DR. HASSAN 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	208600000X	Surgery Physician	036.158803	IL
2	390200000X	Student in an Organized Health Care Education/Training Program	125067329	IL
3	208600000X	Surgery Physician	4301505824	MI

General Provider Information

NPI Number	:	1851772057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HASSAN AHMAD M.D

Provider Business Mailing Address
First Line	:	5737 LINCOLN AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3470
Country	:	US
Telephone Number	:	847-877-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 S M 30 STE 216
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9388
Country	:	US
Telephone Number	:	989-343-3130
Fax Number	:	989-343-3112

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

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	02/07/2022

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