Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036145568 | IL |
N | 111NI0900X | Internist | 036145568 | IL |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036145568 | IL |
NPI | 1063895746 |
---|---|
Provider Name | Dr. Yasser Ali Haider |
First Address | Champaign, IL 61820-3909 |
Second Address | Champaign, IL 61822-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 04/01/2022 |