Individual
EHTESHAM J GHANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9223 OGDEN AVENUE, BROOKFIELD, IL 60513
(708) 485-4050
(708) 485-9216
Mailing address
9223 OGDEN AVENUE, BROOKFIELD, IL 60513
(708) 485-4050
(708) 485-9216
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036092503
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623766
BLUE CROSS BLUE SHIELD
—
05
—
036092503
—
IL
Enumeration date
06/09/2006
Last updated
07/14/2010
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