Basic Information
| Provider Information | |||||||||
| NPI: | 1265005482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHA | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | YOUSEF MUSTAFA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 W NELSON ST APT 1304 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738373498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 836 W WELLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739751600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2021 | ||||||||
| LastUpdateDate: | 07/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125.077517 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.