Provider Demographics
NPI:1154366706
Name:HALEEM, AZEEM S (MD)
Entity type:Individual
Prefix:
First Name:AZEEM
Middle Name:S
Last Name:HALEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1394
Mailing Address - Country:US
Mailing Address - Phone:815-786-9988
Mailing Address - Fax:815-786-9986
Practice Address - Street 1:1310 N MAIN
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1394
Practice Address - Country:US
Practice Address - Phone:815-786-9988
Practice Address - Fax:815-786-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084000OtherMEDICAID
IL036084000Medicaid
ILIL6309002OtherMEDICARE INDIVIDUAL
ILIL6309OtherMEDICARE GROUP
IL036084000OtherMEDICAID
ILL80431Medicare ID - Type Unspecified
ILF25637Medicare UPIN