Provider Demographics
NPI:1225664337
Name:MASOOD, WAJIHA IMRAN (PA-C)
Entity Type:Individual
Prefix:
First Name:WAJIHA
Middle Name:IMRAN
Last Name:MASOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5916
Mailing Address - Country:US
Mailing Address - Phone:847-802-7090
Mailing Address - Fax:847-802-7095
Practice Address - Street 1:1465 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5916
Practice Address - Country:US
Practice Address - Phone:847-802-7090
Practice Address - Fax:847-802-7095
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007876363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program