Organization
G-REZA NAZARIAN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
G-REZA NAZARIAN MD (PRESIDENT)
(773) 265-7700
Entity
Organization
Contact information
Practice address
3435 W VAN BUREN ST, CHICAGO, IL 60624-3312
(773) 265-7700
Mailing address
3435 W VAN BUREN ST, CHICAGO, IL 60624-3312
(773) 265-7700
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA4750
PALMETTO GBA
IL
Enumeration date
08/14/2006
Last updated
10/05/2007
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