Individual
BASSAM SOUFAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N PERRYVILLE RD, ROCKFORD, IL 61114-8011
(815) 971-2000
Mailing address
29624 NETWORK PL, CHICAGO, IL 60673-1296
(608) 756-6278
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-077791
IL
207Q00000X
Family Medicine Physician
Primary
036077791
IL
261QU0200X
Urgent Care Clinic/Center
036077791
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077791
—
IL
Enumeration date
08/30/2006
Last updated
04/22/2026
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