Provider Demographics
NPI:1720228752
Name:AHMED FARAG MD PC
Entity Type:Organization
Organization Name:AHMED FARAG MD PC
Other - Org Name:DIAGNOSTIC IMAGING SPECIALISTS OF CHICAGO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-830-3841
Mailing Address - Street 1:60 E DELAWARE PL
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6559
Mailing Address - Country:US
Mailing Address - Phone:312-867-9000
Mailing Address - Fax:312-867-9127
Practice Address - Street 1:60 E DELAWARE PL
Practice Address - Street 2:SUITE 1410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6559
Practice Address - Country:US
Practice Address - Phone:312-867-9000
Practice Address - Fax:312-867-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31242Medicare UPIN