Provider Demographics
NPI:1851483812
Name:HAMIDANI, NASREEN (MD)
Entity Type:Individual
Prefix:
First Name:NASREEN
Middle Name:
Last Name:HAMIDANI
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 1:431 S EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 150
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6557
Practice Address - Country:US
Practice Address - Phone:708-579-5214
Practice Address - Fax:708-579-5216
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208342OtherGROUP MEDICARE PTAN
IL036089626 2Medicaid
IL036089626 2Medicaid
IL208342OtherGROUP MEDICARE PTAN
IL036089626 2Medicaid