Healthcare Provider Details

I. General information

NPI: 1982953006
Provider Name (Legal Business Name): RABIA MANZOOR MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 S CICERO AVE
CHICAGO IL
60804-2411
US

IV. Provider business mailing address

1997 DIVINE DR
ROCKFORD IL
61107-5508
US

V. Phone/Fax

Practice location:
  • Phone: 708-222-9170
  • Fax:
Mailing address:
  • Phone: 317-417-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036121105
License Number StateIL

VIII. Authorized Official

Name: RABIA MANZOOR
Title or Position: DIRECTOR
Credential: MD
Phone: 317-417-5545