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General NPI Number Information
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NPI Number | 1396207346
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Entity Type | Individual
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Provider Name | ASSEM MIARI PA
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 8201 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 202 SW PLEASANT ST
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City | ANKENY
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State | IA
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Zip | 50023-3025
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Country | US
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Telephone | 515-864-1660
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085007422
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12716
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License Number State | TX
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