Provider Demographics
NPI:1679558068
Name:SOBHY, TAHER ANWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHER
Middle Name:ANWAR
Last Name:SOBHY
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 1:1425 N HUNT CLUB RD STE 302
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2639
Mailing Address - Country:US
Mailing Address - Phone:848-244-6900
Mailing Address - Fax:847-680-7454
Practice Address - Street 1:1425 N HUNT CLUB RD STE 302
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2639
Practice Address - Country:US
Practice Address - Phone:847-244-6900
Practice Address - Fax:847-244-6900
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-105153Medicaid
L91945Medicare ID - Type Unspecified