Provider Demographics
NPI:1639123458
Name:KAUR, TANJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:TANJEEV
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17577 SOUTH KEDZIE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-799-1780
Mailing Address - Fax:708-589-3346
Practice Address - Street 1:17577 SOUTH KEDZIE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-799-1780
Practice Address - Fax:708-589-3346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111526207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111526Medicaid
ILK23347Medicare ID - Type Unspecified