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NPI Code Detail

MEDICARE: MR. ASHRAF TAMIZUDDIN M.D.

MEDICARE: MR. ASHRAF TAMIZUDDIN M.D.
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
1207RN0300XNephrology Physician036-097061IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20-488-054-8OTHERECFMG
3076-869-899OTHERRESIDENT VISA
4336-057344OTHERILIL CONTROLLED SUBSTANCE

General Provider Information

NPI Number : 1255302626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ASHRAF TAMIZUDDIN M.D.
Provider Business Mailing Address
First Line : 3401 CONIFER DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-8300
Country : US
Telephone Number : 217-726-0967
Fax Number : 217-726-7633
Provider Business Practice Location Address
First Line : 3401 CONIFER DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-8300
Country : US
Telephone Number : 217-726-0967
Fax Number : 217-726-7633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 03/07/2023

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