Individual
IJAZ QAYYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12251 S 80TH AVE, ST. GEORGE AMBULATORY CENTER, PALOS HEIGHTS, IL 60463-1256
(708) 923-4400
(708) 923-4421
Mailing address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036049622
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036.049622
—
IL
01
—
F400320766
MEDICARE PTAN
IL
Enumeration date
08/24/2006
Last updated
02/06/2018
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