=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215851878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED TAHIR INAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 S CENTRAL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60644-5059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-626-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6320 JOLIET RD APT B15
-----------------------------------------------------
City | COUNTRYSIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-7289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-575-0484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 125.088902
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------