Provider Demographics
NPI:1679762983
Name:AMJAD Z AHMAD MD SC
Entity Type:Organization
Organization Name:AMJAD Z AHMAD MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:Z
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:630-505-8888
Mailing Address - Street 1:3100 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1603
Mailing Address - Country:US
Mailing Address - Phone:630-505-8888
Mailing Address - Fax:630-505-8889
Practice Address - Street 1:3100 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1603
Practice Address - Country:US
Practice Address - Phone:630-505-8888
Practice Address - Fax:630-505-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211974Medicare PIN
ILK37792Medicare PIN
ILG84473Medicare UPIN