Provider Demographics
NPI:1740172667
Name:TLN PROFESSIONAL SERVICES II, PC
Entity type:Organization
Organization Name:TLN PROFESSIONAL SERVICES II, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:INSIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBERAWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-872-7653
Mailing Address - Street 1:1621 W CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2501
Mailing Address - Country:US
Mailing Address - Phone:888-510-0059
Mailing Address - Fax:
Practice Address - Street 1:5661 TELEGRAPH RD STE 4B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4275
Practice Address - Country:US
Practice Address - Phone:888-510-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLN PROFESSIONAL SERVICES II, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty