Healthcare Provider Details

I. General information

NPI: 1396181699
Provider Name (Legal Business Name): HAAJIRA CHEEMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 S BLUE ISLAND AVE
CHICAGO IL
60608-3013
US

IV. Provider business mailing address

1101 E CAMBRIA LN S
LOMBARD IL
60148-3797
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-3355
  • Fax: 312-564-5252
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-004577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: