Individual
MOBEEN A SHIRAZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2441 LAKE SHORE DR, WOODSTOCK, IL 60098-6911
(815) 338-4600
(815) 338-4611
Mailing address
2441 LAKE SHORE DR, WOODSTOCK, IL 60098-6911
(815) 338-4600
(815) 338-4611
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
28079
AL
207YS0123X
Facial Plastic Surgery Physician
Primary
036116362
IL
207YS0123X
Facial Plastic Surgery Physician
28079
AL
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
036116362
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116362
—
IL
Enumeration date
09/06/2007
Last updated
08/07/2024
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