Organization Active NPI

Maimoona Aijaz MDSC

  • Internal Medicine Physician
  • Joliet, IL
National Provider Identifier
1467572503
Registry record updated Jul 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MAIMOONA AIJAZ MDSC
Practice address
1717 Glenwood Ave
Joliet, IL 60435-5835
Phone
(815) 744-8600
NPI assigned
Mar 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sadna Mohan
Title
President
Phone
(630) 904-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1717 Glenwood Ave
Joliet, IL 60435-5835

Mailing address

1717 Glenwood Ave
Joliet, IL 60435-5835
Phone (815) 744-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000075 IL Part B Supplier - Clinic/Group Practice 4385621895 Receives reassigned benefits from 1 practitioner
Practice locations: Joliet, IL

National Provider Directory

National Provider Directory

Locations

1717 Glenwood Ave
Joliet, IL 60435
Phone (815) 744-8600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373241600000",
    "number": "1467572503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355835",
            "telephone_number": "815-744-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355835",
            "telephone_number": "815-744-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIMOONA AIJAZ MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-07-08",
        "status": "A",
        "authorized_official_last_name": "MOHAN",
        "authorized_official_first_name": "SADNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-904-7200"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.