Organization
MINIMALLY INVASIVE THERAPY SPECIALISTS SC
Active
Other names
MITS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IFTIKHAR AHMAD MD (PRESIDENT AND CEO)
(844) 646-8763
Entity
Organization
Contact information
Practice address
5011 N LINCOLN AVE, CHICAGO, IL 60625-6351
(844) 646-8763
(855) 497-2932
Mailing address
5011 N LINCOLN AVE, CHICAGO, IL 60625-6351
(844) 646-8763
(855) 497-2932
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027928G89
INDIVIDUAL MEDICARE PTAN
IL
01
—
068824647
INDIVIDUAL MEDICAID PROVIDER
IL
01
—
1558600106
GROUP NPI
IL
01
—
1922070457
INDIVIDUAL NPI
IL
01
—
IL8727
GROUP PTAN
IL
Enumeration date
02/01/2013
Last updated
10/18/2018
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