Provider Demographics
NPI:1447364526
Name:AHMAD, NASIR J (MD)
Entity type:Individual
Prefix:DR
First Name:NASIR
Middle Name:J
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 1:296 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1534
Mailing Address - Country:US
Mailing Address - Phone:847-697-2691
Mailing Address - Fax:847-697-8370
Practice Address - Street 1:296 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1534
Practice Address - Country:US
Practice Address - Phone:847-697-2692
Practice Address - Fax:847-697-8370
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-045126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045126Medicaid
IL671280Medicare ID - Type Unspecified
IL036045126Medicaid