Provider Demographics
NPI:1255863957
Name:AHMAD, AYSHA
Entity Type:Individual
Prefix:
First Name:AYSHA
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 E BELVIDERE RD
Mailing Address - Street 2:UNIT 385
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2026
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:312-694-0655
Practice Address - Street 1:1475 E BELVIDERE RD
Practice Address - Street 2:SUITE 385
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2012
Practice Address - Country:US
Practice Address - Phone:312-926-0106
Practice Address - Fax:312-694-0655
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program