Provider Demographics
NPI:1790456747
Name:DREW, QAIYIM
Entity Type:Individual
Prefix:
First Name:QAIYIM
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 SIMMS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4703
Mailing Address - Country:US
Mailing Address - Phone:773-732-2877
Mailing Address - Fax:708-713-3020
Practice Address - Street 1:1723 SIMMS ST STE 202
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4703
Practice Address - Country:US
Practice Address - Phone:773-732-2877
Practice Address - Fax:708-713-3020
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL852846842Medicaid