Provider Demographics
NPI:1982953006
Name:RABIA MANZOOR MD LTD
Entity Type:Organization
Organization Name:RABIA MANZOOR MD LTD
Other - Org Name:KID CARE DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RABIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-417-5545
Mailing Address - Street 1:1997 DIVINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5508
Mailing Address - Country:US
Mailing Address - Phone:317-417-5545
Mailing Address - Fax:
Practice Address - Street 1:2254 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60804-2411
Practice Address - Country:US
Practice Address - Phone:708-222-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10900284Medicaid