Provider Demographics
NPI:1881660785
Name:SOLEYMANI, PARVIZ M (MD)
Entity Type:Individual
Prefix:MR
First Name:PARVIZ
Middle Name:M
Last Name:SOLEYMANI
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 1:491 ASHFORD LANE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8035
Mailing Address - Country:US
Mailing Address - Phone:219-763-4818
Mailing Address - Fax:219-763-2658
Practice Address - Street 1:5304 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1555
Practice Address - Country:US
Practice Address - Phone:219-427-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035490B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00209780AMedicaid
IN00209780BMedicaid
D15297Medicare UPIN
IN656800Medicare ID - Type Unspecified