Individual
MARDJAN FOROUTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2111 MIDLANDS CT, SUITE 202, SYCAMORE, IL 60178-3125
(630) 222-5574
Mailing address
PO BOX 967, TINLEY PARK, IL 60477-0967
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036110360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110360
—
IL
Enumeration date
07/09/2006
Last updated
09/29/2008
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