Provider Demographics
NPI:1508062159
Name:HAMDAN, JOEHAR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEHAR
Middle Name:
Last Name:HAMDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23120 S LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7760
Mailing Address - Country:US
Mailing Address - Phone:708-307-2451
Mailing Address - Fax:815-936-5404
Practice Address - Street 1:23120 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-7760
Practice Address - Country:US
Practice Address - Phone:815-464-5440
Practice Address - Fax:815-936-5404
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125224207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125224Medicaid