Provider Demographics
NPI:1962403998
Name:AHMED, AZIZ (MD)
Entity type:Individual
Prefix:DR
First Name:AZIZ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:SUITE 417
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-532-8999
Mailing Address - Fax:224-653-9645
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 417
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-532-8999
Practice Address - Fax:224-653-9645
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087491207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-087491-1Medicaid
ILF83792Medicare UPIN
IL036-087491-1Medicaid