Provider Demographics
NPI:1366857286
Name:TAZUDEEN, NOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NOOR
Middle Name:
Last Name:TAZUDEEN
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 1:4700 N MARINE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7972
Mailing Address - Country:US
Mailing Address - Phone:608-287-2658
Mailing Address - Fax:773-334-3399
Practice Address - Street 1:4700 N MARINE DR STE 220
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7972
Practice Address - Country:US
Practice Address - Phone:608-287-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5930-851207N00000X
IL125065910207R00000X
IL036.146214207N00000X
IN01084857A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine