Provider Demographics
NPI:1215196316
Name:AHMAD, NAURIN EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAURIN
Middle Name:EHSAN
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JOHN DEERE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6869
Mailing Address - Country:US
Mailing Address - Phone:309-779-4200
Mailing Address - Fax:
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134499207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400121050Medicare PIN