Provider Demographics
NPI:1760945091
Name:AHMED, ARUBA SHAHEEN
Entity Type:Individual
Prefix:
First Name:ARUBA
Middle Name:SHAHEEN
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74008272
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:312-635-0050
Practice Address - Street 1:3939 S 92ND ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2140
Practice Address - Country:US
Practice Address - Phone:312-635-0973
Practice Address - Fax:312-635-0050
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81314-21208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation