Individual
AMIRA AL-BASHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1639 N ALPINE RD STE 380, ROCKFORD, IL 61107-1440
(815) 229-9333
(815) 229-7288
Mailing address
1639 N ALPINE RD STE 380, ROCKFORD, IL 61107-1440
(815) 229-9333
(815) 229-7288
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
085.006967
IL
363A00000X
Physician Assistant
085006967
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/04/2018
Last updated
03/20/2026
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