Provider Demographics
NPI:1619322252
Name:NIZAMUDDIN, REHAN AHMED (MD)
Entity Type:Individual
Prefix:
First Name:REHAN
Middle Name:AHMED
Last Name:NIZAMUDDIN
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 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. OF RADIOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1057
Mailing Address - Country:US
Mailing Address - Phone:847-570-2477
Mailing Address - Fax:847-570-2942
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:SUITE 1304
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:224-639-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125068937207R00000X
MO20180149852085R0202X
IL0361560322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine