Provider Demographics
NPI:1962532044
Name:AHMED, AZIZ UDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:AZIZ
Middle Name:UDDIN
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 1:1657 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3201
Mailing Address - Country:US
Mailing Address - Phone:630-261-1393
Mailing Address - Fax:
Practice Address - Street 1:1657 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3201
Practice Address - Country:US
Practice Address - Phone:312-829-1134
Practice Address - Fax:312-829-4602
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13307Medicare UPIN