Individual
ZOHRA F MOEENUDDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
320 E ARMSTRONG AVE, PEORIA, IL 61603-3172
(309) 624-9690
(309) 624-9714
Mailing address
320 E ARMSTRONG AVE, PEORIA, IL 61603-3172
(309) 680-7600
(309) 495-8614
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01061030A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01061030B
CSR
IN
05
—
036113542
—
IL
01
—
11520388
CAQH
—
05
—
200533760
—
IN
01
—
809840
MEDICARE GROUP PTAN
IL
Enumeration date
06/19/2006
Last updated
03/07/2023
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