Provider Demographics
NPI:1841371648
Name:RASLAN, AHMAD O (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:O
Last Name:RASLAN
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 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:133 E BRUSH HILL RD STE 310
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5662
Practice Address - Country:US
Practice Address - Phone:331-221-9003
Practice Address - Fax:331-221-2743
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057301A207RP1001X, 207R00000X, 207RC0200X
IL036-101274207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200440260AMedicaid
IN000000296423OtherANTHEM PROVIDER NUMBER
IN000000296423OtherANTHEM PROVIDER NUMBER
160170DMedicare ID - Type Unspecified