Healthcare Provider Details

I. General information

NPI: 1477253631
Provider Name (Legal Business Name): MOHAMMAD TAUSEEF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E IRVING PARK RD
ITASCA IL
60143-2300
US

IV. Provider business mailing address

241 W EDWARD ST
LOMBARD IL
60148-3854
US

V. Phone/Fax

Practice location:
  • Phone: 630-875-0244
  • Fax:
Mailing address:
  • Phone: 312-823-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051303672
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303672
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: