MEDICARE: MURTUZA H BAHRAINWALA 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	207R00000X	Internal Medicine Physician	11055	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871590679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MURTUZA H BAHRAINWALA MD

Provider Business Mailing Address
First Line	:	509 LUCAS LN
Second Line	:
City	:	FORSYTH
State	:	IL
Zip	:	62535-8978
Country	:	US
Telephone Number	:	217-791-5071
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 LUCAS LN
Second Line	:
City	:	FORSYTH
State	:	IL
Zip	:	62535-8978
Country	:	US
Telephone Number	:	217-791-5071
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/23/2010

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