Provider Demographics
NPI:1538504493
Name:AZAR, HASSAN G (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:G
Last Name:AZAR
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 1:15538 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4595
Mailing Address - Country:US
Mailing Address - Phone:708-340-8147
Mailing Address - Fax:
Practice Address - Street 1:3800 W 203RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1184
Practice Address - Country:US
Practice Address - Phone:708-679-2661
Practice Address - Fax:708-503-3860
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.087480207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400101250OtherMEDICARE PTAN
OHG90915Medicare UPIN