Basic Information
| Provider Information | |||||||||
| NPI: | 1114368271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAHIR | ||||||||
| FirstName: | SUMBUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6025 N HIAWATHA AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606465825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737990841 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 N MARINE DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125062810 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.