NPIMap

Individual provider Active NPI

Noor Tazudeen, M.D.

  • Dermatology Physician
  • Chicago, IL
National Provider Identifier
1366857286
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036.146214 Issued in IL
Practice address
4700 N Marine Dr Ste 220
Chicago, IL 60640-7972
Phone
(608) 287-2658
NPI assigned
Jun 30, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 5930-851 WI
Internal Medicine Physician 207R00000X 125065910 IL
Dermatology Physician 207N00000X 036.146214 IL Primary
Dermatology Physician 207N00000X 01084857A IN

Addresses

Primary practice location

4700 N Marine Dr Ste 220
Chicago, IL 60640-7972

Mailing address

4700 N Marine Dr Ste 220
Chicago, IL 60640-7972
Phone (608) 287-2658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180831001952 IL Practitioner - Dermatology 1355661653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Hospital & facility affiliations

  • John H Stroger Jr Hospital Hospital, Chicago, IL, CCN 140124

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions18
Removal or shaving of skin growth1-10
Skin biopsy18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.146214ILMDDermatology Physician
5930-851WIMDDermatology Physician
125065910ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Cook County Dermatology CurrentSince Jul 26, 2024 Accepting new patients
Cook County CurrentSince Jul 26, 2024 Accepting new patients
University Dermatology and Vein Clinic LLC Dermatology CurrentSince Aug 1, 2018 Accepting new patients
John H Stroger Jr Hospital Cook County Past Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

4700 N Marine Dr
Ste 220
Chicago, IL 60640
Phone (217) 516-0669

8110 Cass Ave
Darien, IL 60561
Phone (630) 920-1900

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/J3trBeALwJU1F3hepm2v21jJ96hxu50P/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1366857286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 N MARINE DR STE 220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407972",
            "telephone_number": "608-287-2658",
            "fax_number": "773-334-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N MARINE DR STE 220",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407972",
            "telephone_number": "608-287-2658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAZUDEEN",
        "first_name": "NOOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "5930-851",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125065910",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.146214",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01084857A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.