Basic Information
| Provider Information | |||||||||
| NPI: | 1275525271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUADRI | ||||||||
| FirstName: | TARIQ | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PROFESSIONAL DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184638610 | ||||||||
| FaxNumber: | 6184638688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PROFESSIONAL DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184638610 | ||||||||
| FaxNumber: | 6184638688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | MD15601 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | M-5124 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 036113044 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 207219 | 01 | IL | GROUP PTAN | OTHER |