Healthcare Provider Details

I. General information

NPI: 1447446257
Provider Name (Legal Business Name): FARAH TAZEEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MAIN ST STE O
LOMBARD IL
60148-4526
US

IV. Provider business mailing address

23 W MADISON ST
VILLA PARK IL
60181-3018
US

V. Phone/Fax

Practice location:
  • Phone: 630-785-3255
  • Fax:
Mailing address:
  • Phone: 630-785-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036.118381
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036118381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: