=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558563148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AFREEN ANJUM HYDER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 W HIGH ST LOWR LEVEL
-----------------------------------------------------
City | MORRIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60450-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-941-9320
-----------------------------------------------------
Fax | 815-705-1774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 1ST ST SW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55905-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-838-5222
-----------------------------------------------------
Fax | 630-889-8977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 036.124005
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 4301082246
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 20829
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------