Provider Demographics
NPI:1902167398
Name:SATYENDRA KUMAR HUMAD MD SC
Entity Type:Organization
Organization Name:SATYENDRA KUMAR HUMAD MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYENDRA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:HUMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-866-8988
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-866-8988
Mailing Address - Fax:847-866-8990
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-866-8988
Practice Address - Fax:847-866-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-02
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064710207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064710Medicaid
ILC41398Medicare UPIN
IL754120Medicare PIN