Healthcare Provider Details

I. General information

NPI: 1013769520
Provider Name (Legal Business Name): HAKAN BAHADIR HABERAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 09/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST UI HEALTH
CHICAGO IL
60612
US

IV. Provider business mailing address

765 W ADAMS STREET ARKADIA WEST LOOP 1509
CHICAGO IL
60661
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.083134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: