Healthcare Provider Details

I. General information

NPI: 1811340292
Provider Name (Legal Business Name): JAILAN HANAFY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 W NORTHWEST HWY
PALATINE IL
60067-1897
US

IV. Provider business mailing address

15 MEDICAL PARK STE 141 GENERAL PSYCHIATRY DEPARTMENT
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 847-577-7705
  • Fax: 803-434-4062
Mailing address:
  • Phone: 803-434-1433
  • Fax: 803-434-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL39847
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036148981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: