Provider Demographics
NPI:1447446257
Name:TAZEEN, FARAH (MD)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:TAZEEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S MAIN ST STE O
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4526
Mailing Address - Country:US
Mailing Address - Phone:630-991-0072
Mailing Address - Fax:
Practice Address - Street 1:1300 S MAIN ST STE O
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4526
Practice Address - Country:US
Practice Address - Phone:630-991-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118381207RR0500X
IL036118381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine