Provider Demographics
NPI:1336407998
Name:AZIZ, AMMARA (MD)
Entity Type:Individual
Prefix:
First Name:AMMARA
Middle Name:
Last Name:AZIZ
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 1:15 S MCHENRY RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6705
Mailing Address - Country:US
Mailing Address - Phone:847-618-0326
Mailing Address - Fax:847-618-0762
Practice Address - Street 1:15 S MCHENRY RD FL 3
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6705
Practice Address - Country:US
Practice Address - Phone:847-618-0326
Practice Address - Fax:847-618-0762
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57461-20207R00000X
IL036154001207RE0101X
IL125056074207R00000X
IN01077435A207RE0101X
OK30661207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201387380Medicaid
IL036154001OtherSTATE LICENSE