Healthcare Provider Details

I. General information

NPI: 1033733787
Provider Name (Legal Business Name): HUZEFA MUSTAFA BHOPALWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST
DECATUR IL
62526-4163
US

IV. Provider business mailing address

2300 N EDWARD ST
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-2400
  • Fax: 217-876-2405
Mailing address:
  • Phone: 217-876-2400
  • Fax: 217-876-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036179403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: