Healthcare Provider Details

I. General information

NPI: 1811950892
Provider Name (Legal Business Name): PREM S VIRDI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 30TH ST
ROCK ISLAND IL
61201-7038
US

IV. Provider business mailing address

4600 30TH ST
ROCK ISLAND IL
61201-7038
US

V. Phone/Fax

Practice location:
  • Phone: 309-788-5524
  • Fax: 309-788-9550
Mailing address:
  • Phone: 309-788-5524
  • Fax: 309-788-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PREM S VIRDI
Title or Position: PHYSICIAN
Credential:
Phone: 309-788-5524