Provider Demographics
NPI:1952375800
Name:AHMAD, AMJAD Z (MD)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:Z
Last Name:AHMAD
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 1:3100 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1647
Mailing Address - Country:US
Mailing Address - Phone:630-505-8888
Mailing Address - Fax:630-505-8889
Practice Address - Street 1:3100 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1647
Practice Address - Country:US
Practice Address - Phone:630-505-8888
Practice Address - Fax:630-505-8889
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36102876207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36102876Medicaid
CN5008OtherMEDICARE RAILROAD
CN5008OtherMEDICARE RAILROAD
IL588010Medicare ID - Type Unspecified
ILL98014Medicare ID - Type Unspecified