Provider Demographics
NPI:1891802203
Name:RAZMINIA, MANSOUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOUR
Middle Name:
Last Name:RAZMINIA
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 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-296-7135
Mailing Address - Fax:773-296-7982
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-7135
Practice Address - Fax:773-296-7982
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36098803207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059421Medicaid
ILH02593Medicare UPIN