Provider Demographics
NPI:1063668192
Name:AHMED, IFFAT SULTANA (DO)
Entity Type:Individual
Prefix:MISS
First Name:IFFAT
Middle Name:SULTANA
Last Name:AHMED
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1964 SPRINGBROOK SQUARE DR STE 108B
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5949
Practice Address - Country:US
Practice Address - Phone:630-348-3840
Practice Address - Fax:630-848-9342
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-125768207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125768Medicaid
208342OtherGROUP MEDICARE PTAN