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Individual

IZAZ SHAIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1407 N VETERANS PKWY STE 12, BLOOMINGTON, IL 61704-6425
(201) 852-2435
Mailing address
1726 EIDE RD, BLOOMINGTON, IL 61704-8734
(201) 852-2435

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19033699
IL

Other

Enumeration date
06/09/2022
Last updated
06/09/2022
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