Provider Demographics
NPI:1811254303
Name:MUBARAK, TARIQ MOH'D SULEIMAN (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:MOH'D SULEIMAN
Last Name:MUBARAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MADISON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4210
Mailing Address - Country:US
Mailing Address - Phone:708-486-2700
Mailing Address - Fax:708-486-2702
Practice Address - Street 1:101 MADISON ST STE 300
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4210
Practice Address - Country:US
Practice Address - Phone:708-486-2700
Practice Address - Fax:708-486-2702
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine