Provider Demographics
NPI:1619431970
Name:SULTANA, AYESHA MEHER (MD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:MEHER
Last Name:SULTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AYESHA
Other - Middle Name:M
Other - Last Name:SULTANA-ALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6348 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3902 W ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3910
Practice Address - Country:US
Practice Address - Phone:847-477-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-045384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine