Provider Demographics
NPI:1063417343
Name:QAYYUM, NAHEED MALIK (MD)
Entity type:Individual
Prefix:DR
First Name:NAHEED
Middle Name:MALIK
Last Name:QAYYUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5629
Mailing Address - Country:US
Mailing Address - Phone:630-323-1822
Mailing Address - Fax:630-323-1450
Practice Address - Street 1:6827 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOW BROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5154
Practice Address - Country:US
Practice Address - Phone:630-655-1212
Practice Address - Fax:630-655-6945
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064138207K00000X
IL336028568207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064138Medicaid
ILC49148Medicare UPIN