Provider Demographics
NPI:1912177130
Name:WALID M HAFEZ MD PC
Entity Type:Organization
Organization Name:WALID M HAFEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAFEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-223-3636
Mailing Address - Street 1:1828 STATE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5166
Mailing Address - Country:US
Mailing Address - Phone:217-223-3636
Mailing Address - Fax:
Practice Address - Street 1:1828 STATE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5166
Practice Address - Country:US
Practice Address - Phone:217-223-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44916Medicare UPIN
IL219960Medicare PIN