Basic Information
| Provider Information | |||||||||
| NPI: | 1356590137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TONY J NAHHAS MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6444 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606462935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736315858 | ||||||||
| FaxNumber: | 7736315895 | ||||||||
| Practice Location | |||||||||
| Address1: | 6444 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606462935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736315858 | ||||||||
| FaxNumber: | 7736315895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 11/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | NAHHAS | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7736315858 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036088623 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036088623 | 05 | IL | MEDICAID |