1063668192 NPI number — MISS IFFAT SULTANA AHMED D.O.

Table of content: MISS IFFAT SULTANA AHMED D.O. (NPI 1063668192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063668192 NPI number — MISS IFFAT SULTANA AHMED D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
IFFAT
Provider Middle Name:
SULTANA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1063668192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-469-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1964 SPRINGBROOK SQUARE DR STE 108B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-5949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-348-3840
Provider Business Practice Location Address Fax Number:
630-848-9342
Provider Enumeration Date:
08/08/2008

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: 207R00000X , with the licence number:  036-125768 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036125768 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208342 . This is a "GROUP MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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