Provider Demographics
NPI:1912651258
Name:BIZIMANA, JEROME B
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:B
Last Name:BIZIMANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 SERENDIPITY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4389
Mailing Address - Country:US
Mailing Address - Phone:331-250-6589
Mailing Address - Fax:
Practice Address - Street 1:671 SERENDIPITY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4389
Practice Address - Country:US
Practice Address - Phone:331-250-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver