Provider Demographics
NPI:1942485735
Name:ANSAR, SAMEER (MD)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:ANSAR
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 1:5668 E STATE ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2490
Mailing Address - Country:US
Mailing Address - Phone:815-381-7790
Mailing Address - Fax:
Practice Address - Street 1:5668 E STATE ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2490
Practice Address - Country:US
Practice Address - Phone:815-381-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119752207R00000X
AZ40260207R00000X
IL036-119752207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
833160014Medicare PIN