Provider Demographics
NPI:1164439386
Name:HAQQANI, MOHAMMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:S
Last Name:HAQQANI
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 1:1341 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3437
Mailing Address - Country:US
Mailing Address - Phone:630-275-1125
Mailing Address - Fax:630-275-5802
Practice Address - Street 1:1341 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3437
Practice Address - Country:US
Practice Address - Phone:630-275-1125
Practice Address - Fax:630-275-5802
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA975522084P0800X
IL0361546372084P0800X
ME0162742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME339570099Medicaid