Individual
TARA MOJTAHED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(219) 455-9766
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.163801
IL
207L00000X
Anesthesiology Physician
125.075889
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/08/2019
Last updated
07/28/2024
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