Provider Demographics
NPI:1013154327
Name:HUMAYUN, WASAY (MD)
Entity Type:Individual
Prefix:DR
First Name:WASAY
Middle Name:
Last Name:HUMAYUN
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 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3657
Mailing Address - Country:US
Mailing Address - Phone:773-784-2101
Mailing Address - Fax:773-784-0771
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:STE 700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3657
Practice Address - Country:US
Practice Address - Phone:773-784-2101
Practice Address - Fax:773-784-0771
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.053851207Q00000X
IL036126420207RN0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology