Healthcare Provider Details

I. General information

NPI: 1356397210
Provider Name (Legal Business Name): M TAHIR SHEIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7234 OGDEN AVE SUITE 3N
RIVERSIDE IL
60546-2269
US

IV. Provider business mailing address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3401
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-2277
  • Fax: 708-447-2274
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036050645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: