Provider Demographics
NPI:1720066111
Name:HEDAYATI, HADI (MD)
Entity Type:Individual
Prefix:DR
First Name:HADI
Middle Name:
Last Name:HEDAYATI
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 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1345 EDWARDS ST STE 1
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1692
Practice Address - Country:US
Practice Address - Phone:815-942-9299
Practice Address - Fax:815-941-6431
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048715207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048715-4Medicaid
IL808070Medicare ID - Type Unspecified
IL036048715-4Medicaid