Provider Demographics
NPI:1568473874
Name:BAXAMUSA, HONEID MOHSIN (MD)
Entity Type:Individual
Prefix:
First Name:HONEID
Middle Name:MOHSIN
Last Name:BAXAMUSA
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 1:460 COVENTRY LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7561
Mailing Address - Country:US
Mailing Address - Phone:815-455-1550
Mailing Address - Fax:815-455-9515
Practice Address - Street 1:460 COVENTRY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7561
Practice Address - Country:US
Practice Address - Phone:815-455-1550
Practice Address - Fax:815-455-9515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
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
ILC37227Medicare UPIN
IL207620Medicare ID - Type Unspecified