Organization · Type 2 NPI

Ifath G. Bashiruddin M.d.s.c.

Specialist · Belleville, IL

NPI number 1821287293 Active

Practice location

4550 Memorial Dr, Suite 410
Belleville, IL 62226-5359

Call (618) 234-8246 Map

Fax (618) 234-8271

Mailing address

3415 Saluki Woods Rd
Belleville, IL 62223-7017

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XNone listed

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1821287293

Ifath G. Bashiruddin M.d.s.c.'s National Provider Identifier is 1821287293, issued on Oct 22, 2007. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Belleville, IL. The record was last updated on Nov 5, 2007.