MEDICARE: AAMAIR TAJUDDIN D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	036139508	IL

General Provider Information

NPI Number	:	1689916058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AAMAIR TAJUDDIN D.O.

Provider Business Mailing Address
First Line	:	725 SCHOOL ST STE A
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1207
Country	:	US
Telephone Number	:	815-705-1405
Fax Number	:	815-941-4363

Provider Business Practice Location Address
First Line	:	4 E NORTH ST
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1087
Country	:	US
Telephone Number	:	815-518-5755
Fax Number	:	815-705-1718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/19/2019

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