Provider Demographics
NPI:1720721822
Name:NASER, AMJAD
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:
Last Name:NASER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2940
Mailing Address - Country:US
Mailing Address - Phone:224-406-1045
Mailing Address - Fax:
Practice Address - Street 1:5362 W LAWRENCE AVE STE CW
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3659
Practice Address - Country:US
Practice Address - Phone:224-406-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician