Healthcare Provider Details

I. General information

NPI: 1396978979
Provider Name (Legal Business Name): MUNAWAR SULTANA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-4767
US

IV. Provider business mailing address

1120 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-4767
US

V. Phone/Fax

Practice location:
  • Phone: 847-342-1554
  • Fax: 608-371-8938
Mailing address:
  • Phone: 847-342-1554
  • Fax: 608-371-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number036130663
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036130663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: