MEDICARE: DR. TRACEY L HASHEMI MD

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	207P00000X	Emergency Medicine Physician	01087544A	IN
2	207P00000X	Emergency Medicine Physician	036095011	IL
3	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	036095011	IL
4	207P00000X	Emergency Medicine Physician	4301505849	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	IL3519018	OTHER	IL	MEDICARE PTAN
3	P01146483	OTHER	IL	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508857905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY L HASHEMI MD

Provider Business Mailing Address
First Line	:	405 LAKE ZURICH RD
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3141
Country	:	US
Telephone Number	:	847-381-5599
Fax Number	:	847-381-8042

Provider Business Practice Location Address
First Line	:	405 LAKE ZURICH RD
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3141
Country	:	US
Telephone Number	:	847-381-5599
Fax Number	:	847-381-8042

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	04/28/2022

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