Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036104408 | IL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036104408 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036-104408 | IL |
NPI | 1801956768 |
---|---|
Provider Name | Afshan Hafiz Ahmed |
First Address | La Grange, IL 60525-2600 |
Second Address | La Grange, IL 60525-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 17/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036104408 | (05) | IL |
208342 | GROUP PTAN (01) | |
H84782 | (02) | |
P00722359 | RAILROAD MEDICARE (01) | IL |