Individual
MR. VATHIAR A TAZUDEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W FAIRCHILD ST, DANVILLE, IL 61832-3745
(217) 431-8400
(217) 431-0387
Mailing address
701 W FAIRCHILD ST, DANVILLE, IL 61832-3745
(217) 431-8400
(217) 431-0387
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036061107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061107
—
IL
Enumeration date
08/08/2006
Last updated
07/08/2007
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