Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036064138 | IL |
Y | 207RA0201X | Internist - Allergy & Immunology | 336028568 | IL |
NPI | 1063417343 |
---|---|
Provider Name | Dr. Naheed Malik Qayyum |
First Address | Burr Ridge, IL 60527-5629 |
Second Address | Willow Brook, IL 60527-5154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 07/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064138 | (05) | IL |
C49148 | (02) | IL |