Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E-4310 | AR |
N | 111NI0900X | Internist | E-4310 | AR |
N | 207RC0200X | Critical Care Medicine | 036105636 | IL |
Y | 207RP1001X | Pulmonary Disease | 036105636 | IL |
NPI | 1083791651 |
---|---|
Provider Name | Kashif Shahzad Bhutto |
First Address | Belleville, IL 62226-5368 |
Second Address | Belleville, IL 62226-5363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105636 | (05) | IL |
H93999 | (02) | IL |