Provider Demographics
NPI:1942317243
Name:AYUB, KAMRAN (MD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:AYUB
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 1:9921 SOUTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-499-5678
Mailing Address - Fax:708-499-5685
Practice Address - Street 1:9921 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-499-5678
Practice Address - Fax:708-499-5685
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119910207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039580OtherLABOR & INDUSTRY
ILCI2250OtherRRM GROUP PTAN
IL036119910Medicaid
P00126611OtherRAILROAD MEDICARE
ILP00609731OtherRRM GROUP
WA8291247Medicaid
WAUS7184341OtherAETNA/USHC SPECIALIST
IL1622260OtherBCBS IL
WA7473AYOtherBLUE SHIELD
WAUS7184341OtherAETNA/USHC SPECIALIST
ILK49777Medicare PIN
WA0039580OtherLABOR & INDUSTRY
ILIL1068007Medicare PIN
ILIL1069006Medicare PIN
WA8803683Medicare PIN