Provider Demographics
NPI:1760453047
Name:AHMAD, FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:AHMAD
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 1:2160 S 1ST AVE
Mailing Address - Street 2:MAGUIRE CENTER, RM 1900
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-8563
Mailing Address - Fax:708-216-4948
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:MAGUIRE CENTER, RM 1900
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-8563
Practice Address - Fax:708-216-4948
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36106108207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36106108Medicaid
ILL90724OtherMEDICARE
ILL90724OtherMEDICARE
H56361Medicare UPIN