Bozorgzadeh, Shahriar

Bozorgzadeh, Shahriar is an individual health care provider with primary practice located at 405 W Jackson St , Carbondale IL 62901-1462. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bozorgzadeh, Shahriar can be contacted via phone (618) 549-0721.

Contact Information

Primary practice address
405 W Jackson St Carbondale IL 62901-1462
Phone: (618) 549-0721
Fax: (618) 457-0469
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-096984 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 36096984 Illinois

Profile Details

NPI number 1194726851
LBN Legal business name Bozorgzadeh, Shahriar
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2005
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194726851 NPPES
Illinois Other 3932056 BLUE SHIELD
Illinois MEDICAID 0360096984 BLUE SHIELD
Illinois MEDICAID 036096984 BLUE SHIELD

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