Provider Demographics
NPI:1477763894
Name:GHABRA & TARSHA MEDICAL INC
Entity Type:Organization
Organization Name:GHABRA & TARSHA MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARSHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-770-3813
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 330
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:312-770-3813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001620115OtherBC/BS
ILDG4614Medicare PIN
IL579620Medicare PIN