Basic Information
| Provider Information | |||||||||
| NPI: | 1750390381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | SAQUIB | ||||||||
| MiddleName: | MAJEED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4543 W FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | WAUKEGAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600858669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603127136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 TOWER CT STE 300 | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475998899 | ||||||||
| FaxNumber: | 8475998897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01056583A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036110372 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200280760 | 05 | IN | MEDICAID |