Healthcare Provider Details

I. General information

NPI: 1215851878
Provider Name (Legal Business Name): SYED TAHIR INAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

IV. Provider business mailing address

6320 JOLIET RD APT B15
COUNTRYSIDE IL
60525-7289
US

V. Phone/Fax

Practice location:
  • Phone: 773-626-4300
  • Fax:
Mailing address:
  • Phone: 917-575-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.088902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: