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General NPI Number Information
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NPI Number | 1972641702
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Entity Type | Organization
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Legal Business Name | IMRAN NISAR MD LTD
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD SUITE 510
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3311
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Country | US
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Telephone | 847-981-3660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | TINLEY PARK
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State | IL
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Zip | 60477-0967
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Country | US
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Telephone | 708-532-6029
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Fax |
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | IMRAN NISAR
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Credential | MD
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Telephone | 708-532-6029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036091258
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License Number State | IL
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