MEDICARE: DR. GHAYUR ULHASSAN QURESHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1205946407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHAYUR ULHASSAN QURESHI MD

Provider Business Mailing Address
First Line	:	2309 SPRING LN
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-6201
Country	:	US
Telephone Number	:	314-964-1578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 SPRING LN
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-6201
Country	:	US
Telephone Number	:	314-964-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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