Healthcare Provider Details

I. General information

NPI: 1194060061
Provider Name (Legal Business Name): UZMA TANVEER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 RIVER BEND DR
DALLAS TX
75247-4914
US

IV. Provider business mailing address

1625 E 75TH ST
CHICAGO IL
60649-3603
US

V. Phone/Fax

Practice location:
  • Phone: 214-743-6146
  • Fax:
Mailing address:
  • Phone: 773-947-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125062506
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036137180
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ6294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: