MEDICARE: GHOUSIA WAJIDA 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	207R00000X	Internal Medicine Physician	35082790	OH
2	207R00000X	Internal Medicine Physician	57644	WI
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036109542	IL

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

General Provider Information

NPI Number	:	1932129384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHOUSIA WAJIDA MD

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD
Second Line	:	CVO
City	:	WINFIELD
State	:	IL
Zip	:	60190-1295
Country	:	US
Telephone Number	:	630-933-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD # CVO
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1222
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/17/2018

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Directions to “ GHOUSIA WAJIDA MD” Practice Location

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