Provider Demographics
NPI:1013292457
Name:RAFIQ AHMED M.D., S.C.
Entity Type:Organization
Organization Name:RAFIQ AHMED M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-388-7028
Mailing Address - Street 1:2310 YORK ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2411
Mailing Address - Country:US
Mailing Address - Phone:708-388-7028
Mailing Address - Fax:708-396-1525
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:708-388-7028
Practice Address - Fax:708-396-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048621261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12723Medicare UPIN