Healthcare Provider Details

I. General information

NPI: 1962206763
Provider Name (Legal Business Name): SAMREEN HASSAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 200
OAK LAWN IL
60453-3072
US

IV. Provider business mailing address

4220 W 95TH ST STE 200
OAK LAWN IL
60453-3072
US

V. Phone/Fax

Practice location:
  • Phone: 708-398-0287
  • Fax: 708-684-0281
Mailing address:
  • Phone: 708-398-0287
  • Fax: 708-684-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.085656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: