Provider Demographics
NPI:1437578168
Name:TAGIURI, OSAMA
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:TAGIURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W PETERSON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5244
Mailing Address - Country:US
Mailing Address - Phone:773-508-9000
Mailing Address - Fax:773-508-1796
Practice Address - Street 1:2300 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5203
Practice Address - Country:US
Practice Address - Phone:773-508-9000
Practice Address - Fax:773-508-1796
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000316246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist