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General NPI Number Information
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NPI Number | 1114180452
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Entity Type | Individual
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Provider Name | TANIA HOSSAIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-4786
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Fax |
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Provider Business Mailing Address
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Address Line | 880 N LAKE SHORE DR APT 12C
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City | CHICAGO
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State | IL
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Zip | 60611-1761
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Country | US
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Telephone | 847-971-4893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125052625
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License Number State | IL
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