MEDICARE: RABIA MANZOOR MD LTD

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
1	208000000X	Pediatrics Physician	036121105	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982953006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RABIA MANZOOR MD LTD

Provider Business Mailing Address
First Line	:	1997 DIVINE DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5508
Country	:	US
Telephone Number	:	317-417-5545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60804-2411
Country	:	US
Telephone Number	:	708-222-9170
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RABIA MANZOOR
Credential	:	MD
Telephone Number	:	317-417-5545

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/05/2012

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