Provider Demographics
NPI:1033693742
Name:MEMON, AHMED HUSSAIN (NP)
Entity type:Individual
Prefix:MR
First Name:AHMED
Middle Name:HUSSAIN
Last Name:MEMON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3213
Mailing Address - Country:US
Mailing Address - Phone:224-478-2533
Mailing Address - Fax:
Practice Address - Street 1:3800 WEST MADISON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624
Practice Address - Country:US
Practice Address - Phone:866-267-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017981363LP0808X
IL209-017981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health