Provider Demographics
NPI:1609369941
Name:HAZARI, HUMERA SADAF (MD)
Entity Type:Individual
Prefix:
First Name:HUMERA
Middle Name:SADAF
Last Name:HAZARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3809
Mailing Address - Country:US
Mailing Address - Phone:312-942-4220
Mailing Address - Fax:
Practice Address - Street 1:1717 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3809
Practice Address - Country:US
Practice Address - Phone:312-942-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL52606207R00000X
IL036157912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine