Provider Demographics
NPI:1154505279
Name:TARANEH S FIROOZI MD SC
Entity Type:Organization
Organization Name:TARANEH S FIROOZI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARANEH
Authorized Official - Middle Name:SAHIHI
Authorized Official - Last Name:FIROOZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-736-6999
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-736-6999
Mailing Address - Fax:773-736-2643
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-736-6999
Practice Address - Fax:773-736-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045349207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045349Medicaid
IL036045349Medicaid
211880Medicare Oscar/Certification