Organization
FAZAL AHMED MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAZAL AHMED (PRESIDENT)
(630) 674-4646
Entity
Organization
Contact information
Practice address
2340 S HIGHLAND AVE, SUITE 370, LOMBARD, IL 60148-5371
(630) 519-3092
Mailing address
2340 S HIGHLAND AVE, SUITE 370, LOMBARD, IL 60148-5371
(630) 873-5425
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902917818
NPI TYPE 1
IL
05
—
202916
—
IL
Enumeration date
07/01/2011
Last updated
12/22/2011
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