Provider Demographics
NPI:1609059740
Name:HAIDAR, GEORGES (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:
Last Name:HAIDAR
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 1:908 N ELM ST STE 404
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3638
Mailing Address - Country:US
Mailing Address - Phone:630-789-3422
Mailing Address - Fax:
Practice Address - Street 1:908 N ELM ST STE 404
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3638
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361448632086S0129X
TXQ00612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340830402OtherCSHCN
TX340830401Medicaid
TX340830401Medicaid