Provider Demographics
NPI:1912978222
Name:EL BZOUR, MONTHER F (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTHER
Middle Name:F
Last Name:EL BZOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 E 1ST ST
Mailing Address - Street 2:STE 214
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3166
Mailing Address - Country:US
Mailing Address - Phone:815-285-5678
Mailing Address - Fax:815-285-5898
Practice Address - Street 1:215 E 1ST ST
Practice Address - Street 2:STE 214
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5678
Practice Address - Fax:815-285-5898
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104657Medicaid
ILK15959OtherMEDICARE
I15009Medicare UPIN