Provider Demographics
NPI:1720183437
Name:HASANAIN, S J (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:J
Last Name:HASANAIN
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 1:675 W NORTH AVE
Mailing Address - Street 2:S J HASANAIN MD SUITE 309
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-450-5757
Mailing Address - Fax:708-344-0095
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-450-5757
Practice Address - Fax:708-344-0095
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045225207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045225Medicaid
303160OtherWELLCARE
21604034OtherBCBS
06000190OtherRAILROAD MEDICARE
06000190OtherRAILROAD MEDICARE
IL471910Medicare ID - Type Unspecified