Individual
BAZAL EHSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-3049
(309) 339-4357
Mailing address
2000 RIDGE LN APT 4, WOODRIDGE, IL 60517-3049
(224) 436-6848
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
036156383
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2018
Last updated
09/21/2021
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