Provider Demographics
NPI:1033151923
Name:SHIRAZI, SYED JAVED (MD)
Entity Type:Individual
Prefix:
First Name:SYED JAVED
Middle Name:
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17333 LA GRANGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7502
Mailing Address - Country:US
Mailing Address - Phone:708-448-9393
Mailing Address - Fax:708-448-7530
Practice Address - Street 1:17333 LA GRANGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7502
Practice Address - Country:US
Practice Address - Phone:708-448-9393
Practice Address - Fax:708-448-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360463482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046348Medicaid
C39736Medicare UPIN
IL036046348Medicaid
ILP04158Medicare PIN