Individual
MARYAH MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1800 N KNOXVILLE AVE STE E, PEORIA, IL 61603-3005
(309) 308-0910
(309) 308-0919
Mailing address
1800 N KNOXVILLE AVE STE E, PEORIA, IL 61603-3005
(309) 308-0910
(309) 308-0919
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD482769
PA
207RR0500X
Rheumatology Physician
Primary
036172307
IL
207RR0500X
Rheumatology Physician
75524
MN
207RR0500X
Rheumatology Physician
C1-0011382
DE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75524
MD LICENSE
MN
Enumeration date
07/18/2010
Last updated
04/10/2026
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