Provider Demographics
NPI:1164511580
Name:WAHEED, HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:
Last Name:WAHEED
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0095
Mailing Address - Country:US
Mailing Address - Phone:815-802-0000
Mailing Address - Fax:815-935-1000
Practice Address - Street 1:70 MEADOWVIEW CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2047
Practice Address - Country:US
Practice Address - Phone:815-802-0000
Practice Address - Fax:815-935-1000
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36116934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine