Healthcare Provider Details

I. General information

NPI: 1295962843
Provider Name (Legal Business Name): AZEMINA K POONJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126
US

IV. Provider business mailing address

172 SCHILLER ST
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-8952
  • Fax: 331-221-3782
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036135243
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036135243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: