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Individual

TIMIR SUDHAKER BAMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301087231
MI
207RC0000X
Cardiovascular Disease Physician
4301087231
MI
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
036-127197
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
4301087231
MI

Other

Enumeration date
02/10/2007
Last updated
01/04/2012
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