Provider Demographics
NPI:1356328058
Name:AHMARI, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:AHMARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 SEVEN BRIDGES DR
Mailing Address - Street 2:STE 230
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1222
Mailing Address - Country:US
Mailing Address - Phone:630-964-9400
Mailing Address - Fax:630-964-9375
Practice Address - Street 1:3540 SEVEN BRIDGES DR
Practice Address - Street 2:STE 230
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1222
Practice Address - Country:US
Practice Address - Phone:630-964-9400
Practice Address - Fax:630-964-9375
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3601017562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101756 1Medicaid
IL2220936OtherBCBS
ILK21180Medicare PIN
IL036101756 1Medicaid