Provider Demographics
NPI:1346401411
Name:BORHANI, AMIR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:ALI
Last Name:BORHANI
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 1:676 N SAINT CLAIR ST STE 800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2978
Mailing Address - Country:US
Mailing Address - Phone:312-695-3737
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:676 N SAINT CLAIR ST STE 800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2978
Practice Address - Country:US
Practice Address - Phone:312-695-3737
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1514312085B0100X
IL0361514312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102841822Medicaid
PA294745Medicare PIN