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General NPI Number Information
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NPI Number | 1851460380
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Entity Type | Individual
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Provider Name | MUHAMMAD MUSHTAQ MD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 707 N LOGAN AVE DANVILLE POLYCLINIC, LTD.
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-431-1100
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Fax | 217-431-2900
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Provider Business Mailing Address
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Address Line | 707 N LOGAN AVE DANVILLE POLYCLINIC, LTD.
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-431-1100
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Fax | 217-431-2900
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036047023
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036047023
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License Number State | IL
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