Provider Demographics
NPI:1326287962
Name:ISMAEL MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:ISMAEL MEDICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANZOOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-703-9277
Mailing Address - Street 1:1049 E WILSON ST STE 170
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2478
Mailing Address - Country:US
Mailing Address - Phone:224-703-9277
Mailing Address - Fax:888-851-9193
Practice Address - Street 1:1049 E WILSON ST STE 170
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2478
Practice Address - Country:US
Practice Address - Phone:224-703-9277
Practice Address - Fax:888-851-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty