Provider Demographics
NPI:1871760934
Name:AHMAD, IMRAN (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
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 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-232-0280
Mailing Address - Fax:630-232-3895
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-232-0280
Practice Address - Fax:630-232-3895
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090255207RC0000X
IL036124567207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL206147119OtherMEDICARE PTAN (INDIVIDUAL)
ILIL8618OtherMEDICARE PTAN (GROUP)
IL036124567Medicaid
ILCA4748OtherRR MEDICARE PTAN (GROUP)
ILF400118904OtherMEDICARE PTAN (INDIVIDUAL)
ILP01098963OtherRR MEDICARE PTAN (INDIVIDUAL)