Provider Demographics
NPI:1528079886
Name:KHAJA, HAMEEDUDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:HAMEEDUDDIN
Middle Name:
Last Name:KHAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3392
Mailing Address - Country:US
Mailing Address - Phone:847-439-7284
Mailing Address - Fax:847-439-0504
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-439-7284
Practice Address - Fax:847-439-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH00096Medicare UPIN