Healthcare Provider Details

I. General information

NPI: 1871957183
Provider Name (Legal Business Name): TALHA QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

IV. Provider business mailing address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7340
  • Fax:
Mailing address:
  • Phone: 815-397-7340
  • Fax: 815-397-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5307
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10056256
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR5307
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36158753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: