Provider Demographics
NPI:1588817605
Name:NABAVI, SEYED MAHMOUD (PA)
Entity type:Individual
Prefix:MR
First Name:SEYED MAHMOUD
Middle Name:
Last Name:NABAVI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:SEYED MAHMOUD
Other - Middle Name:
Other - Last Name:NABAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:6345 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1133
Practice Address - Country:US
Practice Address - Phone:708-499-1545
Practice Address - Fax:708-499-4862
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004504363AM0700X
IL085-004504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical