Healthcare Provider Details

I. General information

NPI: 1508094210
Provider Name (Legal Business Name): OSAMA MUSTAFA QAQI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16519 S ROUTE 59 STE A
PLAINFIELD IL
60586-2608
US

IV. Provider business mailing address

16519 S ROUTE 59 STE A
PLAINFIELD IL
60586-2608
US

V. Phone/Fax

Practice location:
  • Phone: 630-600-0700
  • Fax: 630-600-0701
Mailing address:
  • Phone: 630-600-0700
  • Fax: 630-600-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43010949888
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301094988
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: