Provider Demographics
NPI:1376592717
Name:AGHA, AHMAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:K
Last Name:AGHA
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 1:1600 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1902
Mailing Address - Country:US
Mailing Address - Phone:815-680-6806
Mailing Address - Fax:
Practice Address - Street 1:1367 N DIVISION ST
Practice Address - Street 2:A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1444
Practice Address - Country:US
Practice Address - Phone:815-941-2007
Practice Address - Fax:815-941-2132
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104423207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-523-729-2OtherECFMG CERT #
IL336-065079OtherCONTROLLED SUBSTANCE
ILBK7244697OtherDEA
ILH62278Medicare UPIN
0-523-729-2OtherECFMG CERT #