Provider Demographics
NPI:1568426849
Name:NAGHDI CIACIURA, FIROUZEH (DO)
Entity Type:Individual
Prefix:
First Name:FIROUZEH
Middle Name:
Last Name:NAGHDI CIACIURA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FIROUZEH
Other - Middle Name:
Other - Last Name:NAGHDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7425 JANES AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2356
Mailing Address - Country:US
Mailing Address - Phone:815-300-7764
Mailing Address - Fax:
Practice Address - Street 1:7425 JANES AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2356
Practice Address - Country:US
Practice Address - Phone:815-300-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087105Medicaid
IL990014863OtherRAILROAD MEDICARE
IL990014863Medicare PIN
IL575620Medicare PIN
ILF81184Medicare UPIN