MEDICARE: HAAJIRA CHEEMA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085-004577	IL

General Provider Information

NPI Number	:	1396181699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAAJIRA CHEEMA PA-C

Provider Business Mailing Address
First Line	:	1101 E CAMBRIA LN S
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-3797
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	312-738-3355
Fax Number	:	312-564-5252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	05/14/2013

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