Provider Demographics
NPI:1851316889
Name:AKHTAR, NUSRATH (MD)
Entity Type:Individual
Prefix:DR
First Name:NUSRATH
Middle Name:
Last Name:AKHTAR
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 1:6840 S. MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3493
Mailing Address - Country:US
Mailing Address - Phone:630-852-4551
Mailing Address - Fax:630-852-0131
Practice Address - Street 1:6840 S. MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3493
Practice Address - Country:US
Practice Address - Phone:630-852-4551
Practice Address - Fax:630-852-0131
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076575208000000X
IL036-076575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076575Medicaid
IL036076575Medicaid
L52843Medicare PIN
ILG24823Medicare UPIN