Healthcare Provider Details

I. General information

NPI: 1023933231
Provider Name (Legal Business Name): SAMA IMAD HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N BRAINARD ST
NAPERVILLE IL
60540-4607
US

IV. Provider business mailing address

8518 S 78TH AVE
BRIDGEVIEW IL
60455-1753
US

V. Phone/Fax

Practice location:
  • Phone: 630-637-5100
  • Fax:
Mailing address:
  • Phone: 708-253-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: