Provider Demographics
NPI:1689764615
Name:TEHMINA BAJWA MDSC
Entity Type:Organization
Organization Name:TEHMINA BAJWA MDSC
Other - Org Name:BAJWA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEHMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-907-2424
Mailing Address - Street 1:2424 W. INDIAN TRAIL RD.
Mailing Address - Street 2:STE B
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-907-2424
Mailing Address - Fax:630-907-2444
Practice Address - Street 1:2424 W INDIAN TRL
Practice Address - Street 2:STE B
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1568
Practice Address - Country:US
Practice Address - Phone:630-907-2424
Practice Address - Fax:630-907-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105087261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH67874Medicare UPIN