Individual
MR. ASHRAF TAMIZUDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 CONIFER DR, SPRINGFIELD, IL 62711-8300
(217) 726-0967
(217) 726-7633
Mailing address
3401 CONIFER DR, SPRINGFIELD, IL 62711-8300
(217) 726-0967
(217) 726-7633
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036-097061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-488-054-8
ECFMG
—
05
—
036-097061
—
IL
01
—
076-869-899
RESIDENT VISA
—
01
—
336-057344
IL CONTROLLED SUBSTANCE
IL
Enumeration date
02/01/2006
Last updated
03/07/2023
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