=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598757718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUFADDAL M HAMADEH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2005
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17333 LA GRANGE RD STE 200
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60487-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-342-1900
-----------------------------------------------------
Fax | 708-745-9993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17901 GOVERNORS HWY STE 208
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-957-2100
-----------------------------------------------------
Fax | 708-745-9993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 036080978
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 036080978
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------