Provider Demographics
NPI:1437477270
Name:IJAZ QAYYUM M.D.,S.C.
Entity Type:Organization
Organization Name:IJAZ QAYYUM M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:QAYYUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-361-0718
Mailing Address - Street 1:7530 W COLLEGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1196
Mailing Address - Country:US
Mailing Address - Phone:708-361-0718
Mailing Address - Fax:708-361-1379
Practice Address - Street 1:7530 W COLLEGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1196
Practice Address - Country:US
Practice Address - Phone:708-361-0718
Practice Address - Fax:708-361-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049622208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42488Medicare UPIN