Provider Demographics
NPI:1467504894
Name:TAIWO, AFIZ (MD)
Entity Type:Individual
Prefix:
First Name:AFIZ
Middle Name:
Last Name:TAIWO
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 1:309 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2911
Mailing Address - Country:US
Mailing Address - Phone:708-334-9494
Mailing Address - Fax:708-489-5827
Practice Address - Street 1:6423 S COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2747
Practice Address - Country:US
Practice Address - Phone:219-937-3632
Practice Address - Fax:219-937-4715
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN256960FMedicare UPIN
IN256960Medicare PIN
ILK24201Medicare ID - Type Unspecified