Healthcare Provider Details

I. General information

NPI: 1538504493
Provider Name (Legal Business Name): HASSAN G AZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST SUITE 202
OLYMPIA FIELDS IL
60461-1184
US

IV. Provider business mailing address

15538 LAKESIDE DR
ORLAND PARK IL
60467-4595
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2661
  • Fax: 708-503-3860
Mailing address:
  • Phone: 708-340-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036.087480
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036.087480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: