Provider Demographics
NPI:1275572331
Name:AHUJA, AAKASH B (MD)
Entity Type:Individual
Prefix:
First Name:AAKASH
Middle Name:B
Last Name:AHUJA
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 1:655 DEERFIELD RD
Mailing Address - Street 2:SUITE 100 PMB 418
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3241
Mailing Address - Country:US
Mailing Address - Phone:708-667-4333
Mailing Address - Fax:708-667-4334
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-667-4333
Practice Address - Fax:708-667-4334
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0870262085R0202X
AL000237472085R0202X
VA01160104942085R0202X
IL2085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK37907Medicare PIN
I40176Medicare UPIN