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General NPI Number Information
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NPI Number | 1184764706
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Entity Type | Individual
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Provider Name | NASIRUDDIN MANSURY MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 611 W. PARK STREET NEONALOGY
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City | URBANA
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State | IL
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Zip | 61801-2500
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Country | US
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Telephone | 217-383-3395
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Fax | 217-383-3463
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Provider Business Mailing Address
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Address Line | 611 W. PARK ST. FAPC
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City | URBANA
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State | IL
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Zip | 61801-2500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 036111882
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036111882
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036111882
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036111882
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License Number State | IL
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