Provider Demographics
NPI:1255302626
Name:TAMIZUDDIN, ASHRAF (MD)
Entity Type:Individual
Prefix:MR
First Name:ASHRAF
Middle Name:
Last Name:TAMIZUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8300
Mailing Address - Country:US
Mailing Address - Phone:217-726-0967
Mailing Address - Fax:217-726-7633
Practice Address - Street 1:3401 CONIFER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8300
Practice Address - Country:US
Practice Address - Phone:217-726-0967
Practice Address - Fax:217-726-7633
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097061207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-097061Medicaid
0-488-054-8OtherECFMG
076-869-899OtherRESIDENT VISA
IL336-057344OtherIL CONTROLLED SUBSTANCE
IL336-057344OtherIL CONTROLLED SUBSTANCE
IL036-097061Medicaid