Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036150298 | IL |
NPI | 1619364221 |
---|---|
Provider Name | Tariq Syed Lateef |
First Address | Bloomingdale, IL 60108-3048 |
Second Address | Mount Prospect, IL 60056-6039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 01/06/2020 |