Healthcare Provider Details

I. General information

NPI: 1255125167
Provider Name (Legal Business Name): FNU BAWNA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST RM 1100
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

751 N RUTLEDGE ST RM 1100
SPRINGFIELD IL
62702-4968
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-9730
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.088966
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: