Individual
DR. KHOJASTEH BAHMANBEIGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7464 N CLARK ST, CHICAGO, IL 60626-1620
(847) 316-2500
Mailing address
849 W LAKESIDE PL APT 2E, CHICAGO, IL 60640-6746
(773) 275-8893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036111438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111438
—
IL
01
—
202649964
FEDERAL TAX ID
IL
Enumeration date
01/16/2007
Last updated
06/03/2009
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