Provider Demographics
NPI:1679267710
Name:ROCKFORD PULMONARY CLINIC
Entity type:Organization
Organization Name:ROCKFORD PULMONARY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABASSUM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-566-7781
Mailing Address - Street 1:6078 PALO VERDE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8117
Mailing Address - Country:US
Mailing Address - Phone:815-566-7781
Mailing Address - Fax:
Practice Address - Street 1:6078 PALO VERDE DR STE 4
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8117
Practice Address - Country:US
Practice Address - Phone:815-566-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty