Healthcare Provider Details

I. General information

NPI: 1154757607
Provider Name (Legal Business Name): HAFIZ DEWAN HAMZA KHALID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAFIZ D KHALID M.D

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CHARLES ST STE 300
ROCKFORD IL
61104-2200
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-5888
  • Fax: 779-696-5898
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036165045
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4666-320
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number266070
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036165045
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4666-320
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4666-320
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number266070
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036165045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: