Provider Demographics
NPI:1821046186
Name:BHURGRI, JASMINE NAILA (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NAILA
Last Name:BHURGRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3681
Mailing Address - Country:US
Mailing Address - Phone:815-433-1010
Mailing Address - Fax:815-433-0067
Practice Address - Street 1:1614 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3681
Practice Address - Country:US
Practice Address - Phone:815-433-1010
Practice Address - Fax:815-433-0067
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
098800OtherHEALTH ALLIANCE
IL036112108Medicaid
K10949Medicare ID - Type Unspecified
098800OtherHEALTH ALLIANCE