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NPI Code Detail

MEDICARE: DR. ASMA RAFEEQ ANSARI M.D.

MEDICARE: DR. ASMA RAFEEQ ANSARI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician036122782IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00906492OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1336084349OTHERILCONTROLLED SUBSTANCE LICENSE
235.122131OTHEROHMEDICAL LICENSE
3036122782OTHERILMEDICAL LICENSE NUMBER

General Provider Information

NPI Number : 1114045812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ASMA RAFEEQ ANSARI M.D.
Provider Business Mailing Address
First Line : 159 S BLOOMINGDALE RD
Second Line :
City : BLOOMINGDALE
State : IL
Zip : 60108-1434
Country : US
Telephone Number : 630-529-5950
Fax Number : 630-529-6286
Provider Business Practice Location Address
First Line : 159 S BLOOMINGDALE RD
Second Line :
City : BLOOMINGDALE
State : IL
Zip : 60108-1434
Country : US
Telephone Number : 630-529-5950
Fax Number : 630-529-6286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 02/04/2015

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