Provider Demographics
NPI:1598849895
Name:MAHMOOD, TAHIR (MD)
Entity type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:MAHMOOD
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 1:2500 S HIGHLAND AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7103
Mailing Address - Country:US
Mailing Address - Phone:630-429-9000
Mailing Address - Fax:306-429-9060
Practice Address - Street 1:2500 S HIGHLAND AVE STE 230
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7103
Practice Address - Country:US
Practice Address - Phone:630-429-9000
Practice Address - Fax:630-429-9060
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108276208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108276Medicaid
IL036108276Medicaid