Healthcare Provider Details

I. General information

NPI: 1598741951
Provider Name (Legal Business Name): BASSAM HASHEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 S 80TH AVE
PALOS HEIGHTS IL
60463-1256
US

IV. Provider business mailing address

12251 S 80TH AVE STE 1630
PALOS HEIGHTS IL
60463-1256
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-3388
  • Fax: 708-923-3380
Mailing address:
  • Phone: 708-923-5173
  • Fax: 708-923-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036152607
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number54374
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number54374
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number54374
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: