Provider Demographics
NPI:1881818326
Name:VAFA, AMIR HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:VAFA
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 1:2348 N CLARK ST
Mailing Address - Street 2:APARTMENT 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3457
Mailing Address - Country:US
Mailing Address - Phone:312-498-4805
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA AVENUE AT 15TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-257-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116160208600000X
CAA98340208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116160OtherPHYSICIAN AND SURGEON LIC
CAA98340OtherPHYSICIAN AND SURGEON LIC