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General NPI Number Information
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NPI Number | 1891249793
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Entity Type | Individual
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Provider Name | TARANNUM MUJTABA M.D
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Gender | Female
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4355 MONTGOMERY ROAD
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City | NAPERVILLE
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State | IL
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Zip | 60564
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Country | US
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Telephone | 630-236-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 OGDEN AVE
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City | AURORA
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State | IL
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Zip | 60504-7222
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Country | US
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Telephone | 630-566-2233
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Fax | 630-566-3429
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 036.152572
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036152572
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License Number State | IL
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