Provider Demographics
NPI:1144203647
Name:KASSAR, WAHID (MD)
Entity Type:Individual
Prefix:
First Name:WAHID
Middle Name:
Last Name:KASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3713
Mailing Address - Country:US
Mailing Address - Phone:630-866-3636
Mailing Address - Fax:773-692-2035
Practice Address - Street 1:7447 W TALCOTT AVE STE 221
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3713
Practice Address - Country:US
Practice Address - Phone:630-866-3636
Practice Address - Fax:773-692-2035
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107989207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107989Medicaid
IL206147OtherMEDICARE PTAN (GROUP)
ILF400094850OtherMEDICARE PTAN (INDIVIDUAL)
ILP00078735OtherRR MEDCIARE PTAN (INDIVIDUAL)
IL036107989Medicaid
IL920540Medicare ID - Type Unspecified