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Individual

DR. IMAD QAYYUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12255 S 80TH AVE, PALOS HEIGHTS, IL 60463-1270
(708) 923-4400
(708) 923-4421
Mailing address
12251 S 80TH AVE STE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036.143807
IL
208C00000X
Colon & Rectal Surgery Physician
Primary
036.143807
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036143807
IL
Enumeration date
06/02/2011
Last updated
01/23/2019
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