Provider Demographics
NPI:1073577193
Name:GOLZAR, JAAFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAAFER
Middle Name:A
Last Name:GOLZAR
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 1:10837 S CICERO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6459
Mailing Address - Country:US
Mailing Address - Phone:708-636-7575
Mailing Address - Fax:708-636-6193
Practice Address - Street 1:10837 S CICERO AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6459
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:708-636-6193
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115555207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
IL526200OtherMEDICARE GROUP NUMBER
IL416810OtherMEDICARE GROUP
IL21622931OtherBCBS GROUP PROVIDER NUMBER
ILCI8250OtherPALMETTO GBA GROUP #
IL1528165768OtherGROUP NPI NUMBER
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBERS
ILP00321102OtherRAILROAD MEDICARE WILL
IL236551OtherMEDICARE GROUP
ILP00318032OtherRAILROAD MEDICARE COOK
IL036115555Medicaid
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL1508810086OtherGROUP NPI
IL236550OtherMEDICARE GROUP
ILR03572Medicare PIN
ILCI8250OtherPALMETTO GBA GROUP #
ILK27741Medicare ID - Type Unspecified
I30555Medicare UPIN
IL036115555Medicaid