MEDICARE: TARIQ KHAN NIAZI MD

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	208VP0014X	Interventional Pain Medicine Physician	036163240	IL
2	208100000X	Physical Medicine & Rehabilitation Physician	036163240	IL

General Provider Information

NPI Number	:	1275067522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARIQ KHAN NIAZI MD

Provider Business Mailing Address
First Line	:	2235 OVERLOOK RD
Second Line	:	APT 204
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2347
Country	:	US
Telephone Number	:	630-999-0963
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 OVERLOOK RD
Second Line	:	APT 204
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2347
Country	:	US
Telephone Number	:	630-999-0963
Fax Number	:

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

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	09/05/2023

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