Individual
FAUZIA WANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6824 NEWBURG RD, ROCKFORD, IL 61108-4330
(779) 696-7610
(779) 696-8592
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-155670
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-155670
—
IL
Enumeration date
05/29/2018
Last updated
04/11/2023
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