Gulam Ae Hajat, MD – Pediatrics Physician

Key facts

NPI: 1720182074
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 336019374 (IL)
Practice address: 11808 S Pulaski Rd
Alsip, IL 60803-1608
Phone: (708) 489-6200
Fax: (708) 489-6249
NPI assigned: Sep 8, 2006
Sex: Male
Sole proprietor: No

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 and National Provider Directory roles.

Hajat LTD Pediatrics Physician · Alsip, IL · NPI 1598855702

NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
336019374	IL	MD	Pediatrics Physician

Practice roles

Organization	Specialty	Status	New patients
Hajat LTD	Pediatrics	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	336019374	IL	Yes

Addresses

Primary practice location

11808 S Pulaski Rd
Alsip, IL 60803-1608

Mailing address

28 Deer Path TRL
Burr Ridge, IL 60527-6324
Phone (630) 272-4265

Other identifiers

Identifier	Type	State	Issuer
036054708	Medicaid	IL

Other names

Mr. Gulam Ahmed Hajat Professional name

Other providers in Alsip, IL

All providers in Alsip, IL · Pediatrics Physician in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.