Provider Demographics
NPI:1114674462
Name:MUFAZZAL HAMEED, UN KNOWN
Entity Type:Individual
Prefix:
First Name:UN KNOWN
Middle Name:
Last Name:MUFAZZAL HAMEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4235
Mailing Address - Country:US
Mailing Address - Phone:872-985-8336
Mailing Address - Fax:
Practice Address - Street 1:5540 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-4235
Practice Address - Country:US
Practice Address - Phone:872-985-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician