Healthcare Provider Details

I. General information

NPI: 1073350674
Provider Name (Legal Business Name): HICHAM LAADIMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST # 1080
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

682 S HILLSIDE AVE
ELMHURST IL
60126-4249
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-7117
  • Fax:
Mailing address:
  • Phone: 773-569-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.479780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: