Provider Demographics
NPI:1235179409
Name:NAZERIAN, ALAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:P
Last Name:NAZERIAN
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 1:2000 SPRING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1804
Mailing Address - Country:US
Mailing Address - Phone:630-472-8800
Mailing Address - Fax:630-472-9502
Practice Address - Street 1:2000 SPRING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1804
Practice Address - Country:US
Practice Address - Phone:630-472-8800
Practice Address - Fax:630-472-9502
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360928902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL612742700OtherDEPT. OF LABOR
1636444OtherBCBS
IL036092890Medicaid
IL300110733OtherRR MEDICARE ID
ILP00312639OtherRR MEDICARE ID
IL130771300OtherDEPT. OF LABOR
2215114OtherBCBS
2215114OtherBCBS
ILL70732Medicare PIN
G59394Medicare UPIN
IL036092890Medicaid
1636444OtherBCBS