Provider Demographics
NPI:1669590063
Name:TAHIR NIAZI, MD SC
Entity type:Organization
Organization Name:TAHIR NIAZI, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-237-5544
Mailing Address - Street 1:6020 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1108
Mailing Address - Country:US
Mailing Address - Phone:773-237-5544
Mailing Address - Fax:773-889-0883
Practice Address - Street 1:6020 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1108
Practice Address - Country:US
Practice Address - Phone:773-237-5544
Practice Address - Fax:773-889-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty