Provider Demographics
NPI:1689764920
Name:FIROOZI, TARANEH SAHIHI (MD)
Entity Type:Individual
Prefix:DR
First Name:TARANEH
Middle Name:SAHIHI
Last Name:FIROOZI
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 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-736-6999
Mailing Address - Fax:773-736-2643
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-736-6999
Practice Address - Fax:773-736-2643
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045349207N00000X
IL36-045349207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045349Medicaid
IL001619Medicaid
211880Medicare ID - Type Unspecified
IL036045349Medicaid