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General NPI Number Information
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NPI Number | 1235012949
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Entity Type | Individual
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Provider Name | NASSAR PATNI MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 7702 N ALPINE RD
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City | LOVES PARK
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State | IL
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Zip | 61111-3107
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Country | US
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Telephone | 815-971-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5423 MAPLELEAF CIR
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City | ROCKFORD
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State | IL
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Zip | 61108-8080
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Country | US
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Telephone | 443-817-7692
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.085763
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License Number State | IL
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