Provider Demographics
NPI:1093190076
Name:KAGALWALLA, MUSTAFA HUNAID (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:HUNAID
Last Name:KAGALWALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3877
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3877
Mailing Address - Country:US
Mailing Address - Phone:815-741-6830
Mailing Address - Fax:815-435-5080
Practice Address - Street 1:3302 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1179
Practice Address - Country:US
Practice Address - Phone:708-898-0811
Practice Address - Fax:708-898-1839
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145474207RN0300X
IN1083795A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology