Individual
MAIMANAT NIZAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 W 69TH ST, CHICAGO, IL 60636-3262
(773) 778-2355
(773) 778-2355
Mailing address
401 TAMERTON PKWY, BURR RIDGE, IL 60527-6347
(630) 654-1021
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
036-069635
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069635
—
IL
Enumeration date
01/30/2007
Last updated
06/13/2013
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