Provider Demographics
NPI:1922019884
Name:KAMBIZ DOWLAT, M.D. LTD
Entity Type:Organization
Organization Name:KAMBIZ DOWLAT, M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-397-1400
Mailing Address - Street 1:60 E DELAWARE PL
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1998
Mailing Address - Country:US
Mailing Address - Phone:312-397-1400
Mailing Address - Fax:312-587-1400
Practice Address - Street 1:60 E DELAWARE PL
Practice Address - Street 2:SUITE 1400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1998
Practice Address - Country:US
Practice Address - Phone:312-397-1400
Practice Address - Fax:312-587-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214525Medicare PIN