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General NPI Number Information
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NPI Number | 1437477270
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Entity Type | Organization
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Legal Business Name | IJAZ QAYYUM M.D.,S.C.
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 7530 W COLLEGE DR SUITE C
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1196
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Country | US
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Telephone | 708-361-0718
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Fax | 708-361-1379
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Provider Business Mailing Address
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Address Line | 7530 W COLLEGE DR SUITE C
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1196
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Country | US
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Telephone | 708-361-0718
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Fax | 708-361-1379
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. IJAZ QAYYUM
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Credential | M.D.
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Telephone | 708-361-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036049622
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License Number State | IL
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