1629259890 NPI number — SAAD Q AZIZ D.O.

Table of content: SAAD Q AZIZ D.O. (NPI 1629259890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629259890 NPI number — SAAD Q AZIZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZIZ
Provider First Name:
SAAD
Provider Middle Name:
Q
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629259890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1S280 SUMMIT AVE
Provider Second Line Business Mailing Address:
COURT A1
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-3984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-889-9889
Provider Business Mailing Address Fax Number:
630-889-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 W NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-889-9889
Provider Business Practice Location Address Fax Number:
630-889-8977
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  336072432 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 02003772A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201004620 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01443935 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000693605 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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