Provider Demographics
NPI:1275553240
Name:AHMED, FAROOQ MASOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAROOQ
Middle Name:MASOOD
Last Name:AHMED
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 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-810-7786
Mailing Address - Fax:847-673-0292
Practice Address - Street 1:5200 MAIN ST STE 201
Practice Address - Street 2:FAMILY PRACTICE/DEPT OF GERIATRICS
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2100
Practice Address - Country:US
Practice Address - Phone:312-423-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062175A207QA0000X
IL036118695207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine