Individual
DR. BAHRAM GHADERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACS
Contact information
Practice address
2900 FOXFIELD ROAD, SUITE 201, ST. CHARLES, IL 60174
(630) 762-9697
(630) 762-9721
Mailing address
2900 FOXFIELD ROAD, SUITE 201, ST. CHARLES, IL 60174
(630) 762-9697
(630) 762-9721
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036096824
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096824
—
IL
01
—
04527510
BCBS IL
IL
Enumeration date
10/05/2006
Last updated
09/19/2007
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