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

NPI #1821287293 in Belleville, Illinois

Provider Information

NPI Number: 1821287293
Entity Type: Organization
Organization Name: Ifath G. Bashiruddin M.d.s.c.
Primary Specialty: Specialist
Enumeration Date: Oct 22, 2007
Last Updated: Nov 5, 2007

Practice Location

Address: 4550 MEMORIAL DR
Address 2: SUITE 410
City: Belleville
State: Illinois
ZIP Code: 62226-5359
Phone: (618) 234-8246

Authorized Official

Name: MR. DEBORAH HAAKE
Title: BUSINESS MANAGER
Phone: (618) 234-8246

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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