MEDICARE: DR. TARANNUM MUJTABA M.D

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	2085N0700X	Neuroradiology Physician	036.152572	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2085R0202X	Diagnostic Radiology Physician	036152572	IL

General Provider Information

NPI Number	:	1891249793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARANNUM MUJTABA M.D

Provider Business Mailing Address
First Line	:	2000 OGDEN AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7222
Country	:	US
Telephone Number	:	630-566-2233
Fax Number	:	630-566-3429

Provider Business Practice Location Address
First Line	:	4355 MONTGOMERY ROAD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564
Country	:	US
Telephone Number	:	630-236-8300
Fax Number	:

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	12/03/2025

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