Individual
DR. GHOLAMALI AFSHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3249 OAK PARK AVE, METROPOLITAN ADVANCED RADIOLOGY, BERWYN, IL 60402-3429
(708) 783-2696
(708) 783-3164
Mailing address
3249 OAK PARK AVE, RADIOLOGY, BERWYN, IL 60402-3429
(708) 783-2696
(708) 783-3164
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
—
IL
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615363
BLUE CROSS GROUP
IL
05
—
36060114
—
IL
01
—
P00365615
RR MEDICARE
IL
Enumeration date
01/06/2006
Last updated
02/14/2008
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