Healthcare Provider Details

I. General information

NPI: 1770234841
Provider Name (Legal Business Name): MOHAMMAD WASEEM KAGZI MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S IL ROUTE 21 STE 120
GURNEE IL
60031-3803
US

IV. Provider business mailing address

731 S IL ROUTE 21 STE 120
GURNEE IL
60031-3803
US

V. Phone/Fax

Practice location:
  • Phone: 847-855-9700
  • Fax: 847-855-8990
Mailing address:
  • Phone: 847-855-9700
  • Fax: 847-855-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD WASEEM KAGZI
Title or Position: OWNER
Credential: MD
Phone: 847-855-9700