Provider Demographics
NPI:1740965755
Name:BAHNASWY, AHMED TAREK (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:TAREK
Last Name:BAHNASWY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N MICHIGAN AVE APT 3105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6639
Mailing Address - Country:US
Mailing Address - Phone:412-586-8147
Mailing Address - Fax:
Practice Address - Street 1:777 N MICHIGAN AVE APT 3105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6639
Practice Address - Country:US
Practice Address - Phone:412-586-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125082836207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program