Provider Demographics
NPI:1003870239
Name:IZHAR, MUNAVVAR (ME)
Entity Type:Individual
Prefix:DR
First Name:MUNAVVAR
Middle Name:
Last Name:IZHAR
Suffix:
Gender:M
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4420
Mailing Address - Country:US
Mailing Address - Phone:708-492-4077
Mailing Address - Fax:708-386-2839
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:SUITE 158 & 160
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7841
Practice Address - Fax:773-493-1430
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100758207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00471286OtherRAILROAD NUMBER
IL1616108OtherBCBS
IL036100758Medicaid
ILH65876Medicare UPIN
IL922820Medicare PIN
IL036100758Medicaid
ILK49552Medicare PIN