Provider Demographics
NPI:1891810677
Name:M. M. AHSAN S.C.
Entity Type:Organization
Organization Name:M. M. AHSAN S.C.
Other - Org Name:DR. AHSAN AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-741-2525
Mailing Address - Street 1:1640 WILLOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-0959
Mailing Address - Country:US
Mailing Address - Phone:815-741-2525
Mailing Address - Fax:815-741-2522
Practice Address - Street 1:1640 WILLOW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-0959
Practice Address - Country:US
Practice Address - Phone:815-741-2525
Practice Address - Fax:815-741-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087646 1Medicaid
IL036069572 1Medicaid
I02352Medicare UPIN
G50611Medicare UPIN
P63954Medicare UPIN
L84427Medicare PIN
633160Medicare PIN
P10864Medicare UPIN
C46138Medicare UPIN
IL036069572 1Medicaid
633320Medicare PIN