Provider Demographics
NPI:1174834931
Name:DREDAR, AHMID (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMID
Middle Name:
Last Name:DREDAR
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 1:2722 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1308
Mailing Address - Country:US
Mailing Address - Phone:312-698-9040
Mailing Address - Fax:855-618-2276
Practice Address - Street 1:2722 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1308
Practice Address - Country:US
Practice Address - Phone:312-698-9040
Practice Address - Fax:855-618-2276
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125375207Q00000X
IL036.161221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine