Provider Demographics
NPI:1154343408
Name:AHMED, RAFIQ (MD)
Entity type:Individual
Prefix:DR
First Name:RAFIQ
Middle Name:
Last Name:AHMED
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 1:2310 YORK ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2411
Mailing Address - Country:US
Mailing Address - Phone:708-388-7028
Mailing Address - Fax:708-396-1525
Practice Address - Street 1:2310 YORK ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2411
Practice Address - Country:US
Practice Address - Phone:708-388-7028
Practice Address - Fax:708-396-1525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL476782Medicare ID - Type Unspecified
ILD12723Medicare UPIN