Provider Demographics
NPI:1255223269
Name:TLN PROFESSIONAL SERVICES II, PC
Entity type:Organization
Organization Name:TLN PROFESSIONAL SERVICES II, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:INSIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBERAWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-872-7653
Mailing Address - Street 1:1621 W CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2501
Mailing Address - Country:US
Mailing Address - Phone:888-510-0059
Mailing Address - Fax:
Practice Address - Street 1:702 E SOUTH TEMPLE STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1487
Practice Address - Country:US
Practice Address - Phone:888-510-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty