Provider Demographics
NPI:1669214003
Name:ALDASHASH, FAHAD (MBBS)
Entity type:Individual
Prefix:
First Name:FAHAD
Middle Name:
Last Name:ALDASHASH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S. MARYLAND AVE
Mailing Address - Street 2:RM S256
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:773-702-6254
Mailing Address - Fax:
Practice Address - Street 1:5841 S. MARYLAND AVE
Practice Address - Street 2:RM S256
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-6254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2025-03-03
Deactivation Date:2025-01-16
Deactivation Code:
Reactivation Date:2025-03-03
Provider Licenses
StateLicense IDTaxonomies
IL125.083093207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine