1497785141 NPI number — DR ASHRAF ABOURAHMA M D LTD

Table of content: (NPI 1497785141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497785141 NPI number — DR ASHRAF ABOURAHMA M D LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ASHRAF ABOURAHMA M D LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1497785141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5702 W 95TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-952-1040
Provider Business Mailing Address Fax Number:
708-952-1060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5702 W 95TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-952-1040
Provider Business Practice Location Address Fax Number:
708-952-1060
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABOURAHMA
Authorized Official First Name:
ASHRAF
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-952-1040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036086472 , 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: 060069634 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1626734 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036086472 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199793062487 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7418171 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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