Healthcare Provider Details

I. General information

NPI: 1497845135
Provider Name (Legal Business Name): HUMAIRA BARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HUMAIRA BEGUM

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

IV. Provider business mailing address

2400 N. ROCKTON AVENUE
ROCKFORD IL
61103
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-4066
  • Fax: 815-971-9299
Mailing address:
  • Phone: 815-971-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036112309
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036112309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: