Provider Demographics
NPI:1033455118
Name:ASHLAND MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:ASHLAND MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-624-9783
Mailing Address - Street 1:830 N ASHLAND AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5684
Mailing Address - Country:US
Mailing Address - Phone:312-624-9783
Mailing Address - Fax:312-929-3323
Practice Address - Street 1:830 N ASHLAND AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5684
Practice Address - Country:US
Practice Address - Phone:312-624-9783
Practice Address - Fax:312-929-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103729207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty