Provider Demographics
NPI:1306028147
Name:AYESHA AKBAR, M. D ., S.C.
Entity Type:Organization
Organization Name:AYESHA AKBAR, M. D ., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-464-7212
Mailing Address - Street 1:10181 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1274
Mailing Address - Country:US
Mailing Address - Phone:815-464-7212
Mailing Address - Fax:815-277-5509
Practice Address - Street 1:10181 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1274
Practice Address - Country:US
Practice Address - Phone:815-464-7212
Practice Address - Fax:815-277-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099651261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099651Medicaid
IL036099651Medicaid
IL210719Medicare PIN