Provider Demographics
NPI:1447233937
Name:KADKHODAIAN, HOOSHMOND (MD)
Entity Type:Individual
Prefix:MR
First Name:HOOSHMOND
Middle Name:
Last Name:KADKHODAIAN
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 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2295
Mailing Address - Fax:312-328-7808
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-562-2295
Practice Address - Fax:312-328-7808
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360465302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036046530Medicaid
IL201827Medicare ID - Type UnspecifiedGROUP 950150
IL036046530Medicaid