Provider Demographics
NPI:1942202825
Name:AKRAM, TAHIRA (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:AKRAM
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 1:175 W LA VERNE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2347
Mailing Address - Country:US
Mailing Address - Phone:909-593-4400
Mailing Address - Fax:909-593-4426
Practice Address - Street 1:175 W LA VERNE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2347
Practice Address - Country:US
Practice Address - Phone:909-593-4400
Practice Address - Fax:909-593-4426
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000363132OtherANTHEM
ILP00345208OtherRR NUMBER
MI4732780Medicaid
ILCE9335OtherRR GROUP NUMBER
CA1528365285Medicaid
MI1604610592OtherBCBS MI
CA1942202825Medicare NSC
ILP00345208OtherRR NUMBER
ILK32244Medicare PIN