Provider Demographics
NPI:1639383631
Name:AHMED, IRAM ALEEM (MD)
Entity Type:Individual
Prefix:
First Name:IRAM
Middle Name:ALEEM
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S. HIGHLAND AVE., SUITE 230
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5363
Mailing Address - Country:US
Mailing Address - Phone:630-429-9000
Mailing Address - Fax:630-429-9060
Practice Address - Street 1:2500 S. HIGHLAND AVE., SUITE 230
Practice Address - Street 2:SUITE 205
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5363
Practice Address - Country:US
Practice Address - Phone:630-429-9000
Practice Address - Fax:630-429-9060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117593207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117593Medicaid
IL036117593Medicaid
ILIL4905001Medicare PIN
ILIL3375001Medicare PIN