Provider Demographics
NPI:1750647855
Name:THINFAST MD NAPERVILLE
Entity Type:Organization
Organization Name:THINFAST MD NAPERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-227-0293
Mailing Address - Street 1:1560 WALL ST
Mailing Address - Street 2:STE 128
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1123
Mailing Address - Country:US
Mailing Address - Phone:630-219-2002
Mailing Address - Fax:
Practice Address - Street 1:1560 WALL ST STE 128
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1300
Practice Address - Country:US
Practice Address - Phone:630-219-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007392207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-126253Medicaid