Provider Demographics
NPI:1174534564
Name:TABRIZ, MUHAMMAD SHAMSE (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SHAMSE
Last Name:TABRIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MD
Other - Middle Name:SHAMSE
Other - Last Name:TABRIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:7804 W COLLEGE DR
Practice Address - Street 2:SUITE 1NW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1025
Practice Address - Country:US
Practice Address - Phone:708-361-5778
Practice Address - Fax:708-361-5631
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108516207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00060304OtherRAILROAD MEDICARE
IL21622441OtherBCBS PROVIDER ID
IL036108516Medicaid
ILP00060304OtherRAILROAD MEDICARE
IL036108516Medicaid
ILP00060304Medicare PIN
IL21622441OtherBCBS PROVIDER ID