Healthcare Provider Details

I. General information

NPI: 1316250715
Provider Name (Legal Business Name): MRS. ANUPAMA JAYDEEP BUZRUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 CLEAVLAND DR
BOLINGBROOK IL
60440-9021
US

IV. Provider business mailing address

552 CLEAVLAND DR
BOLINGBROOK IL
60440-9021
US

V. Phone/Fax

Practice location:
  • Phone: 630-364-4384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: