Provider Demographics
NPI:1124385299
Name:MORTEZA MOHAJER MD
Entity Type:Organization
Organization Name:MORTEZA MOHAJER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAJER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-883-0200
Mailing Address - Street 1:3150 N LAKE SHORE DR
Mailing Address - Street 2:UNIT 31 B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4810
Mailing Address - Country:US
Mailing Address - Phone:773-883-0200
Mailing Address - Fax:773-883-0090
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:773-883-0200
Practice Address - Fax:773-883-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360534962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054276Medicaid