1215224779 NPI number — KAVEH RAHMANI DO

Table of content: KAVEH RAHMANI DO (NPI 1215224779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215224779 NPI number — KAVEH RAHMANI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMANI
Provider First Name:
KAVEH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215224779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27702 NETWORK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60673-1277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-862-7674
Provider Business Mailing Address Fax Number:
708-862-1781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4742 CAL SAG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60445-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-342-3000
Provider Business Practice Location Address Fax Number:
708-342-3060
Provider Enumeration Date:
07/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036-133777 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036133777 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01365070 . This is a "RRM" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".