Provider Demographics
NPI:1497845135
Name:BARI, HUMAIRA (MD)
Entity Type:Individual
Prefix:
First Name:HUMAIRA
Middle Name:
Last Name:BARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HUMAIRA
Other - Middle Name:
Other - Last Name:BEGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 N. ROCKTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103
Mailing Address - Country:US
Mailing Address - Phone:815-971-5000
Mailing Address - Fax:
Practice Address - Street 1:2400 N. ROCKTON AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103
Practice Address - Country:US
Practice Address - Phone:815-971-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112309Medicaid
IL036112309Medicaid
ILK31169Medicare PIN
IL036112309Medicaid