Basic Information
Provider Information | |||||||||
NPI: | 1538504493 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AZAR | ||||||||
FirstName: | HASSAN | ||||||||
MiddleName: | GEORGE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1040 SIERRA DR | ||||||||
Address2: | SUITE 400 | ||||||||
City: | GREENWOOD | ||||||||
State: | IN | ||||||||
PostalCode: | 461437240 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3175284253 | ||||||||
FaxNumber: | 3178658319 | ||||||||
Practice Location | |||||||||
Address1: | 3800 W 203RD ST | ||||||||
Address2: | SUITE 202 | ||||||||
City: | OLYMPIA FIELDS | ||||||||
State: | IL | ||||||||
PostalCode: | 604611184 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7086792661 | ||||||||
FaxNumber: | 7085033860 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2013 | ||||||||
LastUpdateDate: | 11/23/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 036.087480 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 036.087480 | IL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | F400101250 | 01 | IL | MEDICARE PTAN | OTHER |