MEDICARE: MR. IJAZ 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	207R00000X	Internal Medicine Physician	036107581	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
2	036-107581	OTHER	IL	LIC PHY

General Provider Information

NPI Number	:	1861538712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IJAZ AHMAD M.D.

Provider Business Mailing Address
First Line	:	9133 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3512
Country	:	US
Telephone Number	:	773-375-3312
Fax Number	:	773-375-2334

Provider Business Practice Location Address
First Line	:	9133 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3512
Country	:	US
Telephone Number	:	773-375-3312
Fax Number	:	773-375-2334

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	02/02/2022

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