1942317243 NPI number — KAMRAN AYUB MD

Table of content: KAMRAN AYUB MD (NPI 1942317243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942317243 NPI number — KAMRAN AYUB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYUB
Provider First Name:
KAMRAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942317243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9921 SOUTHWEST HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-499-5678
Provider Business Mailing Address Fax Number:
708-499-5685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9921 SOUTHWEST HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-499-5678
Provider Business Practice Location Address Fax Number:
708-499-5685
Provider Enumeration Date:
08/23/2006

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: 207RG0100X , with the licence number:  036119910 , 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: 0039580 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CI2250 . This is a "RRM GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036119910 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00126611 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00609731 . This is a "RRM GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8291247 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: US7184341 . This is a "AETNA/USHC SPECIALIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1622260 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7473AY . This is a "BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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