Provider Demographics
NPI:1821261892
Name:NASEER, JIBRAN (MD)
Entity Type:Individual
Prefix:
First Name:JIBRAN
Middle Name:
Last Name:NASEER
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 1:11 RASPBERRY RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2816
Mailing Address - Country:US
Mailing Address - Phone:517-759-6974
Mailing Address - Fax:
Practice Address - Street 1:11 RASPBERRY RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2816
Practice Address - Country:US
Practice Address - Phone:517-759-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282E00000X
IL036-128203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No282E00000XHospitalsLong Term Care Hospital