Provider Demographics
NPI:1245379320
Name:HAMEEDUDDIN, RAFIYA (DO)
Entity Type:Individual
Prefix:
First Name:RAFIYA
Middle Name:
Last Name:HAMEEDUDDIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RAFIYA
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:IM HOSPITALISTS STE 4210
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-570-1010
Mailing Address - Fax:847-733-5108
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:IM HOSPITALISTS STE 4210
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-1010
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091808208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL036091808Medicaid
IL0222075OtherBLUE CROSS GROUP NUMBER
IL036091808OtherSTATE LICENSE
ILIL2797003Medicare PIN
IL206147Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL036091808Medicaid
ILP01013244Medicare PIN
IL0222075OtherBLUE CROSS GROUP NUMBER