Basic Information
| Provider Information | |||||||||
| NPI: | 1366438665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAFIZ | ||||||||
| FirstName: | IRFAN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 HALIGUS RD STE 200D | ||||||||
| Address2: | |||||||||
| City: | HUNTLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601429545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478027280 | ||||||||
| FaxNumber: | 8478027275 | ||||||||
| Practice Location | |||||||||
| Address1: | 10350 HALIGUS RD STE 200D | ||||||||
| Address2: | |||||||||
| City: | HUNTLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601429545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478027280 | ||||||||
| FaxNumber: | 8478027275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 036-088772 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 201020880 | 05 | IN | MEDICAID | 036-088-772 | 05 | IL | MEDICAID |