Provider Demographics
NPI:1235114604
Name:JUIRIS, TAHIRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHIRA
Middle Name:A
Last Name:JUIRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAHIRA
Other - Middle Name:A
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1840 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3110
Mailing Address - Country:US
Mailing Address - Phone:847-984-5300
Mailing Address - Fax:847-681-8313
Practice Address - Street 1:1840 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3110
Practice Address - Country:US
Practice Address - Phone:847-984-5300
Practice Address - Fax:847-681-8313
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106084Medicaid
IL036106084Medicaid
ILH73949Medicare UPIN