Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036088898 | IL |
Y | 207RI0011X | Interventional Cardiology | 036088898 | IL |
NPI | 1104805092 |
---|---|
Provider Name | Dr. Faraz Manazir |
First Address | Davenport, IA 52803-2484 |
Second Address | Moline, IL 61265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6189357 | (05) | IA |
H06511 | (02) | |
P00206091 | MEDICARE RAILROAD (01) |