Provider Demographics
NPI:1013096866
Name:SEPAHDARI, AMIR K (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:K
Last Name:SEPAHDARI
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 1:1895 ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8055
Mailing Address - Country:US
Mailing Address - Phone:847-724-2708
Mailing Address - Fax:773-989-6230
Practice Address - Street 1:5145 N CALIFORNIA AVENUE
Practice Address - Street 2:SWEDISH COVENANT HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-989-3814
Practice Address - Fax:773-989-6230
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3T5880Medicare ID - Type Unspecified
I18890Medicare UPIN