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General NPI Number Information
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NPI Number | 1255412193
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Entity Type | Individual
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Provider Name | DARIUSH SAM TAKHTEHCHIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 5TH ROOSEVELT ROAD EDWARD HINES, JR HOSPITAL
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City | HINES
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State | IL
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Zip | 60141
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Country | US
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Telephone | 708-202-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 S PROSPECT AVE SUITE 205
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City | ELMHURST
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State | IL
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Zip | 60126-5643
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Country | US
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Telephone | 630-782-0190
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036-106592
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License Number State | IL
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