Provider Demographics
NPI:1588618482
Name:QURESHI, NAEEM A (MD)
Entity Type:Individual
Prefix:
First Name:NAEEM
Middle Name:A
Last Name:QURESHI
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:3106 OUTER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5270
Practice Address - Country:US
Practice Address - Phone:618-998-0888
Practice Address - Fax:618-993-1808
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360946662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094666Medicaid
IL036094666Medicaid
ILG60361Medicare UPIN
ILK02520Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE