Provider Demographics
NPI:1114050770
Name:DR AHSAN AND ASSOC.
Entity Type:Organization
Organization Name:DR AHSAN AND ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:708-788-2801
Mailing Address - Street 1:1640 WILLOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0959
Mailing Address - Country:US
Mailing Address - Phone:815-741-2525
Mailing Address - Fax:815-741-2522
Practice Address - Street 1:1640 WILLOW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0959
Practice Address - Country:US
Practice Address - Phone:815-741-2525
Practice Address - Fax:815-741-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111596261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center