Provider Demographics
NPI:1356590137
Name:TONY J NAHHAS MD SC
Entity type:Organization
Organization Name:TONY J NAHHAS MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAHHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-631-5858
Mailing Address - Street 1:6444 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2935
Mailing Address - Country:US
Mailing Address - Phone:773-631-5858
Mailing Address - Fax:773-631-5895
Practice Address - Street 1:6444 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2935
Practice Address - Country:US
Practice Address - Phone:773-631-5858
Practice Address - Fax:773-631-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088623Medicaid
IL036088623Medicaid
IL207911Medicare PIN