Provider Demographics
NPI:1639707532
Name:QASEM, ABDELKHALIQ ISAM (MD)
Entity Type:Individual
Prefix:
First Name:ABDELKHALIQ
Middle Name:ISAM
Last Name:QASEM
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 1:15 SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1752
Mailing Address - Country:US
Mailing Address - Phone:708-380-8008
Mailing Address - Fax:
Practice Address - Street 1:15 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1752
Practice Address - Country:US
Practice Address - Phone:708-380-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.076994207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine