Provider Demographics
NPI:1891883641
Name:AMIR, TABASUM (MD)
Entity Type:Individual
Prefix:
First Name:TABASUM
Middle Name:
Last Name:AMIR
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 1:9475 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1542
Mailing Address - Country:US
Mailing Address - Phone:847-298-1445
Mailing Address - Fax:
Practice Address - Street 1:205 W TOUHY AVE STE 104
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4218
Practice Address - Country:US
Practice Address - Phone:847-384-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361148792083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine