Provider Demographics
NPI:1336234970
Name:KASSIM, IRSHAD
Entity Type:Individual
Prefix:
First Name:IRSHAD
Middle Name:
Last Name:KASSIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107
Mailing Address - Country:US
Mailing Address - Phone:630-483-8920
Mailing Address - Fax:630-483-8930
Practice Address - Street 1:180 N BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107
Practice Address - Country:US
Practice Address - Phone:630-483-8920
Practice Address - Fax:630-483-8930
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL96247Medicare ID - Type Unspecified
IL493736Medicare UPIN