Provider Demographics
NPI:1750568960
Name:MOHAMMAD WASEEM KAGZI MD LTD
Entity type:Organization
Organization Name:MOHAMMAD WASEEM KAGZI MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:WASEEM
Authorized Official - Last Name:KAGZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-855-9700
Mailing Address - Street 1:731 S IL ROUTE 21
Mailing Address - Street 2:120
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3813
Mailing Address - Country:US
Mailing Address - Phone:847-855-9700
Mailing Address - Fax:847-855-8990
Practice Address - Street 1:731 S IL RTE 21
Practice Address - Street 2:120
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5258
Practice Address - Country:US
Practice Address - Phone:847-855-9700
Practice Address - Fax:847-855-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091991207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209279Medicare PIN
IL5521460001Medicare NSC