Provider Demographics
NPI:1306832829
Name:RAHMANI, BAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:RAHMANI
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 1:225 EAST CHICAGO AVE.
Mailing Address - Street 2:DIVISION OF PEDIATRIC OPTHALMOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:800-543-7362
Mailing Address - Fax:312-227-9411
Practice Address - Street 1:225 EAST CHICAGO AVE.
Practice Address - Street 2:DIVISION OF PEDIATRIC OPTHALMOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:800-543-7362
Practice Address - Fax:312-227-9411
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036109049207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109049Medicaid
IN200482610AMedicaid
IL1627123OtherBCBS PROVIDER ID