Individual
AHMAD BASTANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6033 N SHERIDAN RD, SUITE S 8, CHICAGO, IL 60660
(773) 506-9600
(773) 506-9655
Mailing address
6033 N SHERIDAN RD, SUITE S 8, CHICAGO, IL 60660
(773) 506-9600
(773) 506-9655
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036082214
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082214
—
IL
01
—
1606175
BLUE CROSS BLUE SHIELD
IL
01
—
4476749
AETNA
IL
Enumeration date
03/31/2006
Last updated
08/17/2016
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