Provider Demographics
NPI:1154757607
Name:KHALID, HAFIZ DEWAN HAMZA
Entity type:Individual
Prefix:
First Name:HAFIZ
Middle Name:DEWAN HAMZA
Last Name:KHALID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HAFIZ
Other - Middle Name:D
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:1340 CHARLES ST STE 300
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2200
Practice Address - Country:US
Practice Address - Phone:779-696-5888
Practice Address - Fax:779-696-5898
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036165045207R00000X, 208M00000X, 207RC0000X
WI4666-320207RC0000X, 208M00000X, 207R00000X
MA266070208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036165045Medicaid