Provider Demographics
NPI:1285633461
Name:HAMEEDUDDIN, ANJUM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJUM
Middle Name:
Last Name:HAMEEDUDDIN
Suffix:
Gender:F
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 1119
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4119
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:4647 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2319
Practice Address - Country:US
Practice Address - Phone:708-747-7720
Practice Address - Fax:708-915-7239
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051648Medicaid
IL489450Medicare PIN
ILK28779Medicare PIN
ILC42304Medicare UPIN
IL036051648Medicaid
ILDE9438Medicare PIN
IL213813Medicare PIN