Healthcare Provider Details

I. General information

NPI: 1215296215
Provider Name (Legal Business Name): BEENISH NAZIR HAFIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST STE 2300
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

201 E MADISON ST
SPRINGFIELD IL
62702-5131
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number64273
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036142682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: