Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036-116150 | IL |
Y | 207RI0011X | Interventional Cardiology | 036116150 | IL |
NPI | 1023037488 |
---|---|
Provider Name | Dr. Nauman Mushtaq |
First Address | Geneva, IL 60134-4220 |
Second Address | Geneva, IL 60134-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 16/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-116150 | STATE LICENSE (01) | IL |
I29053 | (02) | IL |
R01901 | INDIVIDUAL PTAN (01) | IL |