Individual
MOHAMAD FIRAS BAZERBASHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
430 PENNSYLVANIA AVE STE 110, GLEN ELLYN, IL 60137
(630) 946-2020
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036144309
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2012
Last updated
08/03/2023
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