Provider Demographics
NPI:1831175447
Name:TOBIA, NADER N (MD)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:N
Last Name:TOBIA
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 1:9401 S PULASKI RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1924
Mailing Address - Country:US
Mailing Address - Phone:708-425-6225
Mailing Address - Fax:708-425-3456
Practice Address - Street 1:114 N ORCHARD DR
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1200
Practice Address - Country:US
Practice Address - Phone:708-283-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03384Medicare UPIN