Provider Demographics
NPI:1003158403
Name:SHIRANI, LIZA A DAFCHAHI (MD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:A DAFCHAHI
Last Name:SHIRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MASOUMEH
Other - Middle Name:
Other - Last Name:AHMADI DAFCHAHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:836 W WELLINGTON AVE
Mailing Address - Street 2:ROOM 4868
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5147
Mailing Address - Country:US
Mailing Address - Phone:773-975-1600
Mailing Address - Fax:
Practice Address - Street 1:5875 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4937
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:815-381-7498
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036143343207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology