Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036100758 | IL |
N | 111NI0900X | Internist | 036100758 | IL |
Y | 207RN0300X | Nephrologist | 036100758 | IL |
NPI | 1003870239 |
---|---|
Provider Name | Dr. Munavvar Izhar |
First Address | Oak Park, IL 60302-4420 |
Second Address | Chicago, IL 60649-3954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 26/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100758 | (05) | IL |
1616108 | BCBS (01) | IL |
H65876 | (02) | IL |
P00471286 | RAILROAD NUMBER (01) | IL |