Individual
MIR ISAAMULLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2902 MCFARLAND RD STE 100, ROCKFORD, IL 61107-6801
(815) 316-7300
(815) 316-3483
Mailing address
9200 W WISCONSIN AVE # P347, MILWAUKEE, WI 53226-3522
(414) 805-6134
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
036.174735
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2020
Last updated
08/07/2025
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