Healthcare Provider Details

I. General information

NPI: 1588097596
Provider Name (Legal Business Name): ATIF KHAWAJA HASSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE STE 740
CHICAGO IL
60625-7066
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE STE 740
CHICAGO IL
60625-7066
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3957
  • Fax: 773-989-3971
Mailing address:
  • Phone: 773-989-3957
  • Fax: 773-989-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036151549
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036151549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: