Basic Information
| Provider Information | |||||||||
| NPI: | 1932333473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | FARAZ | ||||||||
| MiddleName: | SHAFIQUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126954965 | ||||||||
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| Practice Location | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126954965 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2009 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT194990 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 036.132788 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | MT194990 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RA0001X | 036.132788 | IL | Y |
No ID Information.