1881824019 NPI number — OLFAT AHMED PT

Table of content: OLFAT AHMED PT (NPI 1881824019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881824019 NPI number — OLFAT AHMED PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
OLFAT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881824019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
361 S FRONTAGE RD
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
BURR RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527-5830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-920-4670
Provider Business Mailing Address Fax Number:
630-920-4689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 RIDGE RD
Provider Second Line Business Practice Location Address:
UNIT G
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-2800
Provider Business Practice Location Address Fax Number:
219-836-2897
Provider Enumeration Date:
07/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05009686A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)