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Individual

DR. AHMAD H AHMAD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1770 E LAKE SHORE DR, SUITE 201, DECATUR, IL 62521-3832
(217) 428-7921
(217) 428-7931
Mailing address
1770 E LAKE SHORE DR, SUITE 201, DECATUR, IL 62521-3832
(217) 428-7921
(217) 428-7931

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
030108732
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036108732
IL
01
05832029
BLUE CROSS/BLUE SHIELD
IL
01
113690990
FED TAX ID #
ID
01
612624
HEALTHLINK
IL
Enumeration date
12/21/2005
Last updated
07/19/2010
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