Provider Demographics
NPI:1053866392
Name:HAFEEZ, TAHIR
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 W CRESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-2804
Mailing Address - Country:US
Mailing Address - Phone:708-243-6596
Mailing Address - Fax:708-486-7023
Practice Address - Street 1:1917 W CRESTVIEW CIR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-2804
Practice Address - Country:US
Practice Address - Phone:708-243-6596
Practice Address - Fax:708-486-7023
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver