Provider Demographics
NPI:1275550964
Name:HUMAYUN, HAMID M (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:M
Last Name:HUMAYUN
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 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-784-2101
Mailing Address - Fax:773-784-0771
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-784-2101
Practice Address - Fax:773-784-0771
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053426207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-053426OtherILL LICENSE-
IL316-00757-78OtherBLUECROSS BLUE SHEILD
IL036-053426Medicaid
IL036-053426Medicaid
IL767520Medicare ID - Type Unspecified