Individual
DR. MANI MAHDAVIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 N RIVER RD STE 210, DES PLAINES, IL 60016-1272
(847) 290-3800
(847) 290-0889
Mailing address
150 N RIVER RD STE 210, DES PLAINES, IL 60016-1272
(847) 290-3800
(847) 290-0889
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036095201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095201
—
IL
01
—
100016030
RAIL ROAD MEDICARE
IL
Enumeration date
12/01/2006
Last updated
08/22/2024
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