Provider Demographics
NPI:1063032415
Name:AHSAN, ALIYA (DO)
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:AHSAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RIDGE AVE STE 5323
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2455
Mailing Address - Country:US
Mailing Address - Phone:847-570-2505
Mailing Address - Fax:847-570-2905
Practice Address - Street 1:2500 RIDGE AVE STE 5323
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2455
Practice Address - Country:US
Practice Address - Phone:847-570-2505
Practice Address - Fax:847-570-2905
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036164875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program