Provider Demographics
NPI:1740249218
Name:JAFRI, MAQSOOD H (MD)
Entity type:Individual
Prefix:DR
First Name:MAQSOOD
Middle Name:H
Last Name:JAFRI
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 1:7421 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2607
Mailing Address - Country:US
Mailing Address - Phone:847-873-9367
Mailing Address - Fax:224-246-8127
Practice Address - Street 1:7421 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2607
Practice Address - Country:US
Practice Address - Phone:847-873-9367
Practice Address - Fax:224-246-8127
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099382208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099382Medicaid
IL036099382Medicaid
ILK53036Medicare PIN