Provider Demographics
NPI:1003869553
Name:AHSAN, MALEEHA A (MD)
Entity type:Individual
Prefix:DR
First Name:MALEEHA
Middle Name:A
Last Name:AHSAN
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 1:1341 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3437
Mailing Address - Country:US
Mailing Address - Phone:630-719-5454
Mailing Address - Fax:630-719-1263
Practice Address - Street 1:1341 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3437
Practice Address - Country:US
Practice Address - Phone:630-719-5454
Practice Address - Fax:630-719-1263
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360896812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089681Medicaid
ILK27026Medicare ID - Type Unspecified
ILG19253Medicare UPIN