Provider Demographics
NPI:1851772057
Name:AHMAD, HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3470
Mailing Address - Country:US
Mailing Address - Phone:847-877-9719
Mailing Address - Fax:
Practice Address - Street 1:2431 S M 30 STE 216
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9388
Practice Address - Country:US
Practice Address - Phone:989-343-3130
Practice Address - Fax:989-343-3112
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.158803208600000X
IL125067329390200000X
MI4301505824208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program