Provider Demographics
NPI:1376537357
Name:QAZI, MASOOD A (MD,FACC)
Entity Type:Individual
Prefix:DR
First Name:MASOOD
Middle Name:A
Last Name:QAZI
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S CICERO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6459
Mailing Address - Country:US
Mailing Address - Phone:708-636-7575
Mailing Address - Fax:708-636-6193
Practice Address - Street 1:10837 S CICERO AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6459
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:708-636-6193
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048052207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048052Medicaid
IL060053890OtherPALMETTO GBA INDIVIDUAL #
ILCI8250OtherPALMETTO GBA GROUP #
IL21622931OtherBCBS GROUP #
IL21622931OtherBCBS GROUP #
ILL67855Medicare ID - Type UnspecifiedMEDICARE INDIV PROV ID #
IL388180Medicare ID - Type UnspecifiedANOTHER MEDICARE GROUP #