Provider Demographics
NPI:1245246321
Name:AHMED, IMTIAZ (DPT)
Entity Type:Individual
Prefix:MR
First Name:IMTIAZ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W HIGGINS RD STE 1278
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2051
Mailing Address - Country:US
Mailing Address - Phone:847-277-7930
Mailing Address - Fax:847-277-7932
Practice Address - Street 1:2500 W HIGGINS RD STE 1280
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-278-7580
Practice Address - Fax:847-278-7582
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011932251E00000X
IL070013280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1760830210OtherROYAL HELP HEALTH SERVICES INC.
ILK17857Medicare ID - Type UnspecifiedPT PROVIDER
ILK02225Medicare ID - Type UnspecifiedPT PROVIDER
ILP00163270Medicare ID - Type UnspecifiedPT PROVIDER