Healthcare Provider Details

I. General information

NPI: 1104805092
Provider Name (Legal Business Name): FARAZ MANAZIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 36TH AVENUE
MOLINE IL
61265
US

IV. Provider business mailing address

1236 E RUSHOLME ST STE 300
DAVENPORT IA
52803-2484
US

V. Phone/Fax

Practice location:
  • Phone: 309-743-6700
  • Fax: 309-764-2042
Mailing address:
  • Phone: 563-324-2992
  • Fax: 563-324-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036088898
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036088898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: