Provider Demographics
NPI:1366702292
Name:THINFAST MD ROCKFORD
Entity type:Organization
Organization Name:THINFAST MD ROCKFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-227-0293
Mailing Address - Street 1:461 N MULFORD RD
Mailing Address - Street 2:STE 9
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5190
Mailing Address - Country:US
Mailing Address - Phone:815-229-1899
Mailing Address - Fax:
Practice Address - Street 1:461 N MULFORD RD STE 9
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5165
Practice Address - Country:US
Practice Address - Phone:815-229-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007392207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-126253Medicaid