Basic Information
| Provider Information | |||||||||
| NPI: | 1164787263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 N AIRLITE ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478883661 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 87 N AIRLITE ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478883661 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 03/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OP60409592 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OL60289654 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036141521 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.