Provider Demographics
NPI:1093851941
Name:NIZAM, ATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHER
Middle Name:
Last Name:NIZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3818
Mailing Address - Country:US
Mailing Address - Phone:773-394-5260
Mailing Address - Fax:773-394-5271
Practice Address - Street 1:5470 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4031
Practice Address - Country:US
Practice Address - Phone:773-287-7900
Practice Address - Fax:773-287-5923
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360596842Medicaid
ILC44045Medicare UPIN
IL0360596842Medicaid