Healthcare Provider Details

I. General information

NPI: 1346420890
Provider Name (Legal Business Name): JAVED I. BANGASH, M.D.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LARKIN AVE STE 101
ELGIN IL
60123-4405
US

IV. Provider business mailing address

2050 LARKIN AVE STE 101
ELGIN IL
60123-4405
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-9698
  • Fax: 847-742-9743
Mailing address:
  • Phone: 847-742-9698
  • Fax: 847-742-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAVED IQBAL BANGASH
Title or Position: OWNER
Credential: M.D.
Phone: 847-742-9698