Healthcare Provider Details

I. General information

NPI: 1891071536
Provider Name (Legal Business Name): AAMIRAH JEELANI DHAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 WEBER RD
CREST HILL IL
60403-0928
US

IV. Provider business mailing address

2226 WEBER RD
CREST HILL IL
60403-0928
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-3006
  • Fax: 815-729-3308
Mailing address:
  • Phone: 815-729-3006
  • Fax: 815-729-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.099354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: