Provider Demographics
NPI:1417941725
Name:AHMAD, SHAD S (MD)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:S
Last Name:AHMAD
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 1:350 SURRYSE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3217
Mailing Address - Country:US
Mailing Address - Phone:847-320-1900
Mailing Address - Fax:847-320-1136
Practice Address - Street 1:350 SURRYSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-438-2144
Practice Address - Fax:847-438-1597
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine