Healthcare Provider Details

I. General information

NPI: 1205226560
Provider Name (Legal Business Name): ISMAT CHEEMA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2408
US

IV. Provider business mailing address

2 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2408
US

V. Phone/Fax

Practice location:
  • Phone: 618-899-3607
  • Fax:
Mailing address:
  • Phone: 618-899-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.167252
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.167252
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085005378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: