Provider Demographics
NPI:1508857061
Name:HAMID, IMTIAZ (MD)
Entity Type:Individual
Prefix:
First Name:IMTIAZ
Middle Name:
Last Name:HAMID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-799-0180
Mailing Address - Fax:708-799-3839
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-0180
Practice Address - Fax:708-799-3839
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21624320OtherBCBS OF IL
ILCB1134OtherRR MEDICARE
ILCB1134OtherRR MEDICARE
IL473980Medicare ID - Type Unspecified
IL739830Medicare PIN