Provider Demographics
NPI:1245283035
Name:HASHIM, MUFADDAL M (MD)
Entity type:Individual
Prefix:
First Name:MUFADDAL
Middle Name:M
Last Name:HASHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3600 E STATE ST
Mailing Address - Street 2:SUITE 328
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1978
Mailing Address - Country:US
Mailing Address - Phone:815-397-5554
Mailing Address - Fax:815-397-0993
Practice Address - Street 1:5666 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2425
Practice Address - Country:US
Practice Address - Phone:815-395-5240
Practice Address - Fax:815-227-2447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH29244Medicare UPIN
ILL87952Medicare ID - Type Unspecified