Healthcare Provider Details

I. General information

NPI: 1033279815
Provider Name (Legal Business Name): ASAD A BAKIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 1/2 NORTH AVE
RIVER FOREST IL
60305-1133
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-4888
  • Fax: 708-366-7510
Mailing address:
  • Phone: 630-573-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036050525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: