Organization
FOROUTAN & ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARDJAN FOROUTAN MD (OWNER)
(630) 222-5574
Entity
Organization
Contact information
Practice address
2111 MIDLANDS CT, SUITE 202, SYCAMORE, IL 60178-3125
(630) 222-5574
Mailing address
920 W PRAIRIE DR STE I, SYCAMORE, IL 60178-3123
(708) 532-6029
(708) 532-6095
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036110360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001932083
BCBS PROVIDER #
IL
Enumeration date
07/09/2006
Last updated
05/21/2015
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