Provider Demographics
NPI:1265451397
Name:MOKHLESI, BABAK (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:MOKHLESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:W448
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-5871
Mailing Address - Fax:773-702-7505
Practice Address - Street 1:UNIVERSITY OF CHICAGO HOSPITALS
Practice Address - Street 2:5841 S. MARYLAND AVE, MC 6026
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-1454
Practice Address - Fax:773-702-4754
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036094442207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH14419Medicare UPIN