Provider Demographics
NPI:1629643994
Name:ASAD UR REHMAN, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ASAD UR REHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 HARLEM AVE STE LL34
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2320
Mailing Address - Country:US
Mailing Address - Phone:708-783-2901
Mailing Address - Fax:
Practice Address - Street 1:MACNEAL CENTER FOR INTERNAL MEDICINE
Practice Address - Street 2:3722 SOUTH HARLEM AVE SUITE LL34
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-783-6566
Practice Address - Fax:708-783-6567
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-078039207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine