Healthcare Provider Details

I. General information

NPI: 1669590063
Provider Name (Legal Business Name): TAHIR NIAZI, MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W DIVERSEY AVE
CHICAGO IL
60639-1108
US

IV. Provider business mailing address

6020 W DIVERSEY AVE
CHICAGO IL
60639-1108
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-5544
  • Fax: 773-889-0883
Mailing address:
  • Phone: 773-237-5544
  • Fax: 773-889-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036087267
License Number StateIL

VIII. Authorized Official

Name: DR. TAHIR NIAZI
Title or Position: PRESIDENT
Credential: MD
Phone: 773-237-5544