Basic Information
| Provider Information | |||||||||
| NPI: | 1063413326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYUB | ||||||||
| FirstName: | ASMA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WINFIELD RD | ||||||||
| Address2: | CENTRALIZED SERVICES 4TH FL | ||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605554025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312216377 | ||||||||
| FaxNumber: | 3312212357 | ||||||||
| Practice Location | |||||||||
| Address1: | 172 E SCHILLER ST | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601262816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219001 | ||||||||
| FaxNumber: | 3312212706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036106793 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036106793 | 05 | IL | MEDICAID | BA7987095 | 01 | FEDERAL DEA # | OTHER |