Provider Demographics
NPI:1679518518
Name:AIJAZ, MAIMOONA S (MD)
Entity type:Individual
Prefix:
First Name:MAIMOONA
Middle Name:S
Last Name:AIJAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9192
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0192
Mailing Address - Country:US
Mailing Address - Phone:815-744-8600
Mailing Address - Fax:815-744-8125
Practice Address - Street 1:1717 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5835
Practice Address - Country:US
Practice Address - Phone:815-744-8600
Practice Address - Fax:815-744-8125
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089451Medicaid
IL14D1025017OtherCLIA
ILP00146150OtherRAILROAD MEDICARE
IL10571792OtherCAQH
ILBA4835231OtherDEA
IL036089451Medicaid
IL10571792OtherCAQH