Healthcare Provider Details

I. General information

NPI: 1700993896
Provider Name (Legal Business Name): ANSARI MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W WASHINGTON ST
PITTSFIELD IL
62363-1349
US

IV. Provider business mailing address

623 W WASHINGTON ST
PITTSFIELD IL
62363-1349
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-4414
  • Fax: 217-285-5600
Mailing address:
  • Phone: 217-285-4414
  • Fax: 217-285-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANSAR H ANSARI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 217-285-4414