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General NPI Number Information
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NPI Number | 1427120849
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Entity Type | Individual
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Provider Name | SHAHIDA TANVEER MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1600 167TH ST STE 250
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City | CALUMET CITY
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State | IL
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Zip | 60409-5484
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Country | US
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Telephone | 708-891-0089
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Fax | 708-891-0681
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Provider Business Mailing Address
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Address Line | 2500 S HIGHLAND AVE STE 350
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City | LOMBARD
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State | IL
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Zip | 60148-7129
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Country | US
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Telephone | 630-916-1400
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Fax | 708-891-0681
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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 | 036083262
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License Number State | IL
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