Individual
PARVIZ B. SANJABI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1335 CEDAR COURT, CARBONDALE, IL 62901
(618) 457-8520
(618) 457-8560
Mailing address
P O BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
(618) 985-6860
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036051114
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051114
—
IL
01
—
133133805
DOL BLACK LUNG
IL
05
—
370966854018
—
IL
01
—
640701001
MEDICARE PTAN
IL
01
—
CF3444
MEDICARE RR GROUP
IL
Enumeration date
11/11/2008
Last updated
04/19/2011
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