Healthcare Provider Details

I. General information

NPI: 1538919485
Provider Name (Legal Business Name): MAHAM HAQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

IV. Provider business mailing address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.084892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: