Provider Demographics
NPI:1508959727
Name:RIAHI, G HOSSEIN M (MD)
Entity Type:Individual
Prefix:MR
First Name:G HOSSEIN
Middle Name:M
Last Name:RIAHI
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 1:4309 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE B205
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:814-385-1950
Mailing Address - Fax:815-385-1073
Practice Address - Street 1:4309 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B205
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:814-385-1950
Practice Address - Fax:815-385-1073
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36048442208600000X, 2086S0127X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0560029872OtherBLUE CROSS BLUE SHIE
IL772450Medicare ID - Type Unspecified
IL0560029872OtherBLUE CROSS BLUE SHIE