Mahtab Tashakori, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036113377 Issued in IL

Practice address

1802 South Mattis Ave
Champaign, IL 61821

Phone

(217) 326-1220

NPI assigned

Jul 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mahtab.tashakori.1@14940.direct.athenahealth.com

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1508895780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6002",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618036002",
            "telephone_number": "217-337-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 SOUTH MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61821",
            "telephone_number": "217-326-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TASHAKORI",
        "first_name": "MAHTAB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036113377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "834340",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "553180",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret A. Szafranski, A.N.P.
• Beth Tabbert, LPC
• Melissa D Talley, DT
• Tami Knell LTD.
• Shellane Marie Tangen, BSN, MSN, FNP-BC
• Andrew J Tate
• Whitley Tate, LPC
• Autumn Tatman
• Tiesha Taylor-Ducker, PMHNP-BC
• Autumn Nicole Taylor

• Family Medicine Physician in Champaign, IL
• Providers in Champaign, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.