Provider Demographics
NPI:1306568639
Name:KASIMU, NTUNZWENIMANA
Entity type:Individual
Prefix:
First Name:NTUNZWENIMANA
Middle Name:
Last Name:KASIMU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8332
Mailing Address - Country:US
Mailing Address - Phone:309-558-7135
Mailing Address - Fax:
Practice Address - Street 1:510 8TH ST APT 102
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8332
Practice Address - Country:US
Practice Address - Phone:309-558-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2540202022344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi