Healthcare Provider Details

I. General information

NPI: 1366741548
Provider Name (Legal Business Name): TAHER VALIKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 25
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6815
  • Fax:
Mailing address:
  • Phone: 312-227-6815
  • Fax: 312-227-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number036144249
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: