MEDICARE: NASHIB HASHMI MD PC

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	207RN0300X	Nephrology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04632050	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528022738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASHIB HASHMI MD PC

Provider Business Mailing Address
First Line	:	401 N WALL ST
Second Line	:	STE 100
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2934
Country	:	US
Telephone Number	:	815-932-7110
Fax Number	:	815-932-7112

Provider Business Practice Location Address
First Line	:	401 N WALL ST
Second Line	:	STE 100
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2934
Country	:	US
Telephone Number	:	815-932-7110
Fax Number	:	815-932-7112

Authorized Official
Title or Position	:	PHYSICIAN NEPHROLOGIST PRESIDENT CO
Name	:	DR. NASHIB HASHMI
Credential	:	MD
Telephone Number	:	815-932-7110

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	08/22/2020

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