Provider Demographics
NPI:1023230851
Name:TAKHTEHCHIAN, MOHAMMAD TAGHI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:TAGHI
Last Name:TAKHTEHCHIAN
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 1:1413 LIMAR LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1521
Mailing Address - Country:US
Mailing Address - Phone:847-729-6526
Mailing Address - Fax:
Practice Address - Street 1:225 EDWARD ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2137
Practice Address - Country:US
Practice Address - Phone:815-895-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-048871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine