Ifath G. Bashiruddin M.D.S.C.

Specialist in Belleville, IL. Organization (NPI-2).

NPI number1821287293

StatusActive

Last updated in NPPESNov 5, 2007

Details

NPI: 1821287293
Entity type: Organization (NPI-2)
Legal business name: Ifath G. Bashiruddin M.D.S.C.
Organization subpart: No
Enumeration date: Oct 22, 2007
Last updated: Nov 5, 2007

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
174400000X	Specialist	036085731	IL	Yes

Practice location

4550 Memorial Dr
Suite 410
Belleville, IL 62226-5359

Phone 618-234-8246 · Fax 618-234-8271

Mailing address

3415 Saluki Woods Rd
Belleville, IL 62223-7017

Phone 618-234-8246 · Fax 618-234-8271

Authorized official

Deborah Haake
Business Manager
6182348246

Is something wrong?

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Other Specialist providers in Belleville, IL

All 22 Specialist providers in Belleville · All 1,953 providers in Belleville

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