Provider Demographics
NPI:1235825829
Name:GIVHAN, PARIS
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:GIVHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1366
Mailing Address - Country:US
Mailing Address - Phone:708-663-4331
Mailing Address - Fax:
Practice Address - Street 1:339 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1366
Practice Address - Country:US
Practice Address - Phone:708-663-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILG15066487622172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver