Provider Demographics
NPI:1629425202
Name:SAADATZADEH, TIRAJEH (MD, MS, BA)
Entity type:Individual
Prefix:
First Name:TIRAJEH
Middle Name:
Last Name:SAADATZADEH
Suffix:
Gender:F
Credentials:MD, MS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 940
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2945
Practice Address - Country:US
Practice Address - Phone:312-926-8358
Practice Address - Fax:312-926-9630
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5057207R00000X, 208M00000X
IL036159488207RI0200X, 208M00000X
IL036.159488207R00000X
NMMD2019-0164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist