Provider Demographics
NPI:1134170624
Name:MUSTAFA, NAZIMA ANJUM (MD)
Entity type:Individual
Prefix:DR
First Name:NAZIMA
Middle Name:ANJUM
Last Name:MUSTAFA
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 1:2020 OGDEN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5898
Mailing Address - Country:US
Mailing Address - Phone:630-692-5563
Mailing Address - Fax:630-692-5564
Practice Address - Street 1:2020 OGDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5898
Practice Address - Country:US
Practice Address - Phone:630-692-5563
Practice Address - Fax:630-692-5564
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1659666907OtherGROUP NPI
IL036108252Medicaid
ILH77502OtherUPIN