Provider Demographics
NPI:1659750511
Name:AGHA MEDICAL INC
Entity Type:Organization
Organization Name:AGHA MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-282-3922
Mailing Address - Street 1:1603 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3274
Mailing Address - Country:US
Mailing Address - Phone:815-680-6806
Mailing Address - Fax:
Practice Address - Street 1:1367 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1444
Practice Address - Country:US
Practice Address - Phone:815-941-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137539207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty