Healthcare Provider Details

I. General information

NPI: 1871280156
Provider Name (Legal Business Name): AYEMA HAQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST STE 3D
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

818 S WOLCOTT AVE STE 6
CHICAGO IL
60612-3704
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-5569
  • Fax: 312-413-7835
Mailing address:
  • Phone: 312-355-6167
  • Fax: 312-413-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number125.088590
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: