Provider Demographics
NPI:1073755021
Name:AFIZ A. TAIWO, MD. MPH. S.C.
Entity Type:Organization
Organization Name:AFIZ A. TAIWO, MD. MPH. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFIZ
Authorized Official - Middle Name:ADEWALE
Authorized Official - Last Name:TAIWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-334-9494
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-0449
Mailing Address - Country:US
Mailing Address - Phone:708-334-9494
Mailing Address - Fax:
Practice Address - Street 1:309 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2911
Practice Address - Country:US
Practice Address - Phone:708-334-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617704207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty