Provider Demographics
NPI:1871571646
Name:YASMEEN, TAHIRA (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:YASMEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:PHYSICAINS OFFICE BUILDING SUITE 102
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-684-6867
Mailing Address - Fax:708-684-6869
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:PHYSICAINS OFFICE BUILDING SUITE 102
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-684-6867
Practice Address - Fax:708-684-6869
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098695207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
471635OtherHEALTHLINK
IL036098695Medicaid
071440OtherHEALTH ALLIANCE
L88056Medicare ID - Type Unspecified