Provider Demographics
NPI:1801956768
Name:HAFIZ AHMED, AFSHAN (MD)
Entity type:Individual
Prefix:
First Name:AFSHAN
Middle Name:
Last Name:HAFIZ AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AFSHAN
Other - Middle Name:FATIMA
Other - Last Name:HAFIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5101 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2600
Mailing Address - Country:US
Mailing Address - Phone:708-245-4073
Mailing Address - Fax:708-245-5614
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-245-4073
Practice Address - Fax:708-245-5614
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104408207Q00000X, 207QG0300X
IL036-104408207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
208342OtherGROUP PTAN
ILP00722359OtherRAILROAD MEDICARE
IL036104408Medicaid
208342OtherGROUP PTAN
H84782Medicare UPIN
K13480Medicare ID - Type Unspecified
H84782Medicare UPIN