Provider Demographics
NPI:1679597637
Name:CHEEMA-HASAN, AYESHA (MD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:CHEEMA-HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N STATE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2862
Mailing Address - Country:US
Mailing Address - Phone:203-606-5153
Mailing Address - Fax:
Practice Address - Street 1:4 WALKER AVE STE B
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1351
Practice Address - Country:US
Practice Address - Phone:708-722-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD146352080P0006X
CT427082080P0006X
IL036.1658492080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics