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Organization
KOOSHA MEDICAL CENTER P C
Active
Organization
KOOSHA MEDICAL CENTER P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBRAHIM GHODSIZADEH M.D. (OWNER)
(773) 794-2100
Entity
Organization
Contact information
Practice address
4438 N MILWAUKEE AVE, CHICAGO, IL 60630-3743
(773) 794-2100
Mailing address
4438 N MILWAUKEE AVE, CHICAGO, IL 60630-3743
(773) 794-2100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0360856071
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360856071
—
IL
Enumeration date
04/05/2011
Last updated
03/07/2023
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