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General NPI Number Information
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NPI Number | 1710144662
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Entity Type | Organization
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Legal Business Name | AURORA INTERNISTS AND PRIMARY CARE SC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1315 N HIGHLAND AVE 104
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City | AURORA
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State | IL
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Zip | 60506-1400
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Country | US
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Telephone | 630-301-8664
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 564
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City | AURORA
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State | IL
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Zip | 60507-0564
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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 | PRESIDENT
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Name | DR. NAZIMA MUSTAFA
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Credential | MD
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Telephone | 630-301-8664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 336069212
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License Number State | IL
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