Healthcare Provider Details

I. General information

NPI: 1194456103
Provider Name (Legal Business Name): MOHAMMED MOIZUL HASSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST STE 403
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5495
  • Fax:
Mailing address:
  • Phone: 312-942-5495
  • Fax: 312-766-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.080257
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036.175601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: