Healthcare Provider Details

I. General information

NPI: 1306943022
Provider Name (Legal Business Name): JUNAID U HAQ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N MARINE DR
CHICAGO IL
60640
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8700
  • Fax: 708-783-0920
Mailing address:
  • Phone: 571-777-5106
  • Fax: 703-563-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21286
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: