Organization
IFATH G. BASHIRUDDIN M.D.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEBORAH HAAKE (BUSINESS MANAGER)
(618) 234-8246
Entity
Organization
Contact information
Practice address
4550 MEMORIAL DR, SUITE 410, BELLEVILLE, IL 62226-5359
(618) 234-8246
(618) 234-8271
Mailing address
3415 SALUKI WOODS RD, BELLEVILLE, IL 62223-7017
(618) 234-8246
(618) 234-8271
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
10/22/2007
Last updated
11/05/2007
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