Healthcare Provider Details

I. General information

NPI: 1528068699
Provider Name (Legal Business Name): HANY M AFRAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 STRATHMOOR DR
ROCKFORD IL
61107-6631
US

IV. Provider business mailing address

6785 WEAVER RD STE D
ROCKFORD IL
61114-8055
US

V. Phone/Fax

Practice location:
  • Phone: 920-451-8142
  • Fax: 920-451-8159
Mailing address:
  • Phone: 920-451-8142
  • Fax: 920-451-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-070631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: