Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 036110401 | IL |
NPI | 1083714091 |
---|---|
Provider Name | Dr. Asma Bano |
First Address | Aurora, IL 60504-4168 |
Second Address | Aurora, IL 60504-4168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 03/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110401 | (05) | IL |