Individual
ASSEM MIARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7000
Mailing address
202 SW PLEASANT ST, ANKENY, IA 50023-3025
(515) 864-1660
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12716
TX
363AS0400X
Surgical Physician Assistant
085007422
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085007422
IDFPR
IL
01
—
PA12716
TMB
TX
Enumeration date
04/01/2019
Last updated
10/30/2019
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