MEDICARE: TAHREER SHATAT DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036139062	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245677749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHREER SHATAT DO

Provider Business Mailing Address
First Line	:	23120 S LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-7760
Country	:	US
Telephone Number	:	815-464-5440
Fax Number	:	815-936-5404

Provider Business Practice Location Address
First Line	:	23120 S LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-7760
Country	:	US
Telephone Number	:	815-464-5440
Fax Number	:	815-936-5404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	02/06/2019

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Directions to “ TAHREER SHATAT DO” Practice Location

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