Provider Demographics
NPI:1093707457
Name:SAFVI, AMJAD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:ALI
Last Name:SAFVI
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 1:26 STAR LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7139
Mailing Address - Country:US
Mailing Address - Phone:630-650-0580
Mailing Address - Fax:708-827-5742
Practice Address - Street 1:721 W STATE ROUTE 22
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2552
Practice Address - Country:US
Practice Address - Phone:708-827-5732
Practice Address - Fax:708-827-5742
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-22152085R0202X
PAMD4535992085R0204X
TXN80592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1739OtherPTAN IL
IL036-099445Medicaid
IL336-059832OtherIL PHARMACY NUMBER
IL036-099445OtherIL MEDICAL LICENSE
AL4997OtherAL MEDICAL LICENSE
IL1739OtherPTAN IL
AL4997OtherAL MEDICAL LICENSE
WIL88717Medicare PIN
ILH50450Medicare UPIN