Provider Demographics
NPI:1497846935
Name:GOLCHINI, HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:GOLCHINI
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 1:600 S 13TH ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-353-0825
Mailing Address - Fax:309-347-1246
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE M
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-353-0825
Practice Address - Fax:309-347-1246
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087712207R00000X, 208M00000X
IL036120513208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2695490Medicaid
9015685OtherBCBS
R01334OtherPTAN
OH2695490Medicaid
OHH033471Medicare PIN