Provider Demographics
NPI:1427211978
Name:BAJWA, RIZMA JALEES (MD)
Entity Type:Individual
Prefix:
First Name:RIZMA
Middle Name:JALEES
Last Name:BAJWA
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:9125 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1441
Practice Address - Country:US
Practice Address - Phone:708-422-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79547208M00000X
IL336104482208M00000X
FLME150374208M00000X
IL036143169207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036143169OtherSTATE LICENSE