Provider Demographics
NPI:1841258266
Name:HASHIM, AHMED (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:HASHIM
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:PO BOX 8577
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7017
Mailing Address - Country:US
Mailing Address - Phone:847-360-1000
Mailing Address - Fax:847-360-1001
Practice Address - Street 1:310 S GREENLEAF ST
Practice Address - Street 2:SUITE 212
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-360-1000
Practice Address - Fax:847-360-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101448174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101448Medicaid
ILIL2600001Medicare PIN
G87293Medicare UPIN
ILIL2600001Medicare PIN