Provider Demographics
NPI:1497732747
Name:TEHRANI, RODNEY (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:TEHRANI
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 1:2160 S FIRST AVE
Mailing Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3313
Mailing Address - Fax:708-216-1259
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3313
Practice Address - Fax:708-216-1259
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36106851207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36106851Medicaid
109163Medicare UPIN
ILK07550Medicare ID - Type Unspecified
IL36106851Medicaid