Provider Demographics
NPI:1255081873
Name:AHMADY, IDA NESSA (DO)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:NESSA
Last Name:AHMADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3175
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE 230
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1095
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-2759
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125079452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program