Provider Demographics
NPI:1447243407
Name:AHMED, IRMA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 E. BOUGHTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-783-9960
Mailing Address - Fax:630-783-9962
Practice Address - Street 1:550 E. BOUGHTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-783-9960
Practice Address - Fax:630-783-9962
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101438207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101438Medicaid
IL036101438Medicaid
G38002Medicare UPIN
K06612Medicare ID - Type Unspecified