Healthcare Provider Details

I. General information

NPI: 1417719329
Provider Name (Legal Business Name): TUBANUR CIFTCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N MULFORD RD
ROCKFORD IL
61107-3874
US

IV. Provider business mailing address

253 ARBOR LN
BLOOMINGDALE IL
60108-1801
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-1000
  • Fax:
Mailing address:
  • Phone: 847-281-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.107369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: