Provider Demographics
NPI:1710393210
Name:FATIMA, NASEEM (MD)
Entity type:Individual
Prefix:DR
First Name:NASEEM
Middle Name:
Last Name:FATIMA
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 1:4415 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1910
Mailing Address - Country:US
Mailing Address - Phone:312-738-3355
Mailing Address - Fax:312-564-5252
Practice Address - Street 1:4415 HARRISON ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1910
Practice Address - Country:US
Practice Address - Phone:312-738-3355
Practice Address - Fax:312-564-5252
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.173043207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.173043OtherSTATE MEDICAL LICENSE