Individual
SHAHROKH N KAYHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20201 CRAWFORD AVE, SUITE 1276, OLYMPIA FIELDS, IL 60461-1010
(555) 555-5555
(555) 555-5554
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7240
(555) 555-5555
(555) 555-5554
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036053401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053401
—
IL
01
—
4673170001
DMERC GROUP
IL
01
—
P00006288/CK6882
MEDICARE RAILROAD
IL
01
—
P00006289/CK6883
MEDICARE RAILROAD
IL
Enumeration date
05/02/2006
Last updated
11/09/2016
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