Healthcare Provider Details

I. General information

NPI: 1346227295
Provider Name (Legal Business Name): KAMIL MUZAFFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE (9608 ROBERTS RD., HICKORY HILLS, IL. 60457)
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE (9608 ROBERTS RD., HICKORY HILLS, IL. 60457)
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-233-5333
  • Fax: 708-233-5348
Mailing address:
  • Phone: 708-233-5333
  • Fax: 708-233-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36094467
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: