Active NPI
Hatimali Imtiaz Husain Mithaiwala, DDS
- Dentist
- Morris, IL
National Provider Identifier
1083477269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.034773
- Practice address
- 1010 W US Route 6
Morris, IL 60450-8942 - Phone
- (815) 942-0010
- NPI assigned
- Jan 31, 2024
- Last updated
- Jan 31, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.034773 | IL | Primary |
Addresses
Primary practice location
1010 W US Route 6
Morris, IL 60450-8942
Mailing address
1010 W US Route 6
Morris, IL 60450-8942
Phone (815) 942-0010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.034773 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Windy City Anesthesia PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Certified Registered Nurse Anesthetist
- Wentzville, MO
- NPI 1447514377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1083477269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 W US ROUTE 6",
"city": "MORRIS",
"state": "IL",
"postal_code": "604508942",
"telephone_number": "815-942-0010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 W US ROUTE 6",
"city": "MORRIS",
"state": "IL",
"postal_code": "604508942",
"telephone_number": "815-942-0010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITHAIWALA",
"first_name": "HATIMALI",
"middle_name": "IMTIAZ HUSAIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-31",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.034773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morris, IL
- Stephanie Louise Mickley, FNP-C
- Heidi Kristina Miller, APN
- Mind Over Matter Psychotherapy P.C.
- Mindful Psychiatric Services, MDSC
- Michelle Lee Mitchell, N.C.
- Reena Raman Modjeski, DMD
- Morris Audiology Inc.
- Morris Comm HS Dist 101
- Morris Eyecare Associates Inc
- Morris Fire Protection & Ambulance District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.