Individual
MODJTABA AMIRAHMADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1855 W TAYLOR ST, CHICAGO, IL 60612-7242
(312) 413-3593
Mailing address
1855 W TAYLOR ST, CHICAGO, IL 60612-7242
(312) 413-3593
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036.117612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI3011
RAILROAD MEDICARE
CA
Enumeration date
05/02/2007
Last updated
12/08/2021
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