Healthcare Provider Details

I. General information

NPI: 1629772538
Provider Name (Legal Business Name): HOZAIFA M ANJUM DPM, AACFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ESSINGTON RD
JOLIET IL
60435-8439
US

IV. Provider business mailing address

951 ESSINGTON RD
JOLIET IL
60435-8439
US

V. Phone/Fax

Practice location:
  • Phone: 630-323-6116
  • Fax:
Mailing address:
  • Phone: 630-323-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016.006171
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0116038483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: