Provider Demographics
NPI:1962718791
Name:AKHTAR, NOORAIN (MD)
Entity type:Individual
Prefix:
First Name:NOORAIN
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3547
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:833-719-1178
Practice Address - Street 1:6450 W TOUHY AVE FL 2
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4512
Practice Address - Country:US
Practice Address - Phone:773-631-2223
Practice Address - Fax:773-631-5607
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132768Medicaid
ILF400397694OtherMEDICARE PTAN