Provider Demographics
NPI:1164787263
Name:AHMED, FATIMA (DO)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
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 1:87 N AIRLITE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4991
Mailing Address - Country:US
Mailing Address - Phone:847-888-3661
Mailing Address - Fax:
Practice Address - Street 1:87 N AIRLITE ST STE 130
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4991
Practice Address - Country:US
Practice Address - Phone:847-888-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60409592207Q00000X
WAOL60289654207Q00000X
IL036141521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine