Doctor Name: | MEHDI BASSIRATPOUR |
NPI Number: | 1356384598 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 036106820 |
Business Practice Address: | 3 S 138 Park Blvd Glen Ellyn, IL - 60137 |
Business Phone Number: | 6306052646 |
Business Fax Number: | 6307900655 |
Mailing Address: | 3 S 138 Park Blvd, GLEN ELLYN |
State: | IL |
Postal Code: | 60137 |
Phone Number: | 6306052646 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 01/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036106820 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |