Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036118695 | IL |
NPI | 1275553240 |
---|---|
Provider Name | Dr. Farooq Masood Ahmed |
First Address | Chicago, IL 60616-2857 |
Second Address | Skokie, IL 60077-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 22/11/2013 |