Bashiruddin, Ifath G
Bashiruddin, Ifath G is an sole proprietor health care provider with primary practice located at 4550 Memorial Dr Suite 360, Belleville IL 62226-5359. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as her primary health care specialty. Bashiruddin, Ifath G can be contacted via phone (618) 239-9500.Contact Information
Primary practice address
4550 Memorial Dr Suite 360
Belleville IL 62226-5359
Phone: (618) 239-9500
Fax: (618) 239-9555
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 036085731 | Illinois |
Profile Details
| NPI number | 1417060534 |
|---|---|
| LBN Legal business name | Bashiruddin, Ifath G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 15th, 2006 |
| Last updated | Jan 31st, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417060534 | NPPES |
| Illinois | Other | 390007921 | RAILROAD MEDICARE |
| Illinois | MEDICAID | 036085731 | RAILROAD MEDICARE |
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