Provider Demographics
NPI:1972561975
Name:ABOURAHMA, ASHRAF H (MD)
Entity type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:H
Last Name:ABOURAHMA
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 1:5702 W 95TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2345
Mailing Address - Country:US
Mailing Address - Phone:708-952-1040
Mailing Address - Fax:708-952-1060
Practice Address - Street 1:5702 W 95TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2345
Practice Address - Country:US
Practice Address - Phone:708-952-1040
Practice Address - Fax:708-952-1060
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086472207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626734OtherBCBS
IL036086472Medicaid
IL199793062487OtherHUMANA
IL7418171OtherAETNA
IL060069634OtherRAILROAD MEDICARE
IL7418171OtherAETNA
IL1626734OtherBCBS