Basic Information
Provider Information | |||||||||
NPI: | 1902965098 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | A.M. ARSHAD M.D. S.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 565 LAKEVIEW PKWY | ||||||||
Address2: | SUITE 192 | ||||||||
City: | VERNON HILLS | ||||||||
State: | IL | ||||||||
PostalCode: | 600611857 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476584574 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 565 LAKEVIEW PKWY | ||||||||
Address2: | SUITE 192 | ||||||||
City: | VERNON HILLS | ||||||||
State: | IL | ||||||||
PostalCode: | 600611857 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476584574 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/06/2006 | ||||||||
LastUpdateDate: | 11/20/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ARSHAD | ||||||||
AuthorizedOfficialFirstName: | ABRAR | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 8476584574 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | 036091755 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics | 2080P0008X | 036091755 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
ID Information
ID | Type | State | Issuer | Description | 036091755 | 05 | IL |   | MEDICAID | 04926936 | 01 | IL | BLUE CROSS/SHIELD | OTHER |