Provider Demographics
NPI:1548575160
Name:BHABHRAWALA, MUNIRA SUBER (DO)
Entity type:Individual
Prefix:
First Name:MUNIRA
Middle Name:SUBER
Last Name:BHABHRAWALA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 N ELSTON AVE
Mailing Address - Street 2:NORTHELSTON IMMEDIATE & PRIMARY CARE/ MARION
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641
Mailing Address - Country:US
Mailing Address - Phone:773-754-3500
Mailing Address - Fax:773-754-3504
Practice Address - Street 1:4332 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2144
Practice Address - Country:US
Practice Address - Phone:773-754-3500
Practice Address - Fax:773-754-3504
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058803207Q00000X
IL036133376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine