Healthcare Provider Details

I. General information

NPI: 1851968481
Provider Name (Legal Business Name): FAHAD TAHIR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MONTGOMERY RD STE 108109
AURORA IL
60504-9078
US

IV. Provider business mailing address

755 KNOCH KNOLLS RD
NAPERVILLE IL
60565-3545
US

V. Phone/Fax

Practice location:
  • Phone: 630-401-8286
  • Fax:
Mailing address:
  • Phone: 630-745-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.006079
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: