MEDICARE: AFIZ A. TAIWO, MD. MPH. S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	042617704	IL
2	207R00000X	Internal Medicine Physician	042617704	IL

General Provider Information

NPI Number	:	1073755021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFIZ A. TAIWO, MD. MPH. S.C.

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-0449
Country	:	US
Telephone Number	:	708-334-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 PINEHURST DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2911
Country	:	US
Telephone Number	:	708-334-9494
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AFIZ ADEWALE TAIWO
Credential	:	M.D.
Telephone Number	:	708-334-9494

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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