Healthcare Provider Details

I. General information

NPI: 1154366706
Provider Name (Legal Business Name): AZEEM S HALEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N MAIN SUITE 200
SANDWICH IL
60548-1394
US

IV. Provider business mailing address

1310 N MAIN ST
SANDWICH IL
60548-1394
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-9988
  • Fax: 815-786-9986
Mailing address:
  • Phone: 815-786-9988
  • Fax: 815-786-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036084000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: