Provider Demographics
NPI:1790897049
Name:SERAJIAN, ASIF (DO)
Entity Type:Individual
Prefix:
First Name:ASIF
Middle Name:
Last Name:SERAJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W BUTTERFIELD RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5043
Mailing Address - Country:US
Mailing Address - Phone:630-869-0888
Mailing Address - Fax:630-834-1017
Practice Address - Street 1:340 W BUTTERFIELD RD STE 3A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5043
Practice Address - Country:US
Practice Address - Phone:630-869-0888
Practice Address - Fax:630-834-1017
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016935207RI0011X
IL036126138207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36073485Medicaid
IL36073485Medicaid