Provider Demographics
NPI:1356464200
Name:TAZBAZ, DANI (MD)
Entity Type:Individual
Prefix:DR
First Name:DANI
Middle Name:
Last Name:TAZBAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE STE 500
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1843
Practice Address - Country:US
Practice Address - Phone:314-925-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111031207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
MO2014039581207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF3444OtherMEDICARE RAILROAD GROUP
IL036111031Medicaid
IL207219OtherMEDICARE PTAN
ILP00421916OtherMEDICARE RAILROAD PIN
IL370966854011Medicaid
IL370966854016Medicaid
IL141967Medicare Oscar/Certification
ILK39870Medicare PIN
IL370966854016Medicaid
IL141088Medicare Oscar/Certification
IL036111031Medicaid
IL370966854011Medicaid
IL141069Medicare Oscar/Certification