Provider Demographics
NPI:1801352414
Name:TAJUDDIN, DILSHAD (APN)
Entity type:Individual
Prefix:
First Name:DILSHAD
Middle Name:
Last Name:TAJUDDIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4455
Mailing Address - Country:US
Mailing Address - Phone:847-530-4098
Mailing Address - Fax:
Practice Address - Street 1:1144 WILMETTE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2604
Practice Address - Country:US
Practice Address - Phone:847-256-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner