Healthcare Provider Details

I. General information

NPI: 1689764920
Provider Name (Legal Business Name): TARANEH SAHIHI FIROOZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST SUITE 203
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

5600 W ADDISON ST SUITE 203
CHICAGO IL
60634
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-6999
  • Fax: 773-736-2643
Mailing address:
  • Phone: 773-736-6999
  • Fax: 773-736-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number36045349
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number36-045349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: