Provider Demographics
NPI:1184774457
Name:MAHMARIAN, ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MAHMARIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15900 SOUTH CICERO AVE
Mailing Address - Street 2:OAK FOREST HOSPITAL DEPARTMENT OF SURGERY
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452
Mailing Address - Country:US
Mailing Address - Phone:708-687-7200
Mailing Address - Fax:708-633-4198
Practice Address - Street 1:15900 SOUTH CICERO AVE
Practice Address - Street 2:OAK FOREST HOSPITAL DEPARTMENT OF SURGERY
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-687-7200
Practice Address - Fax:708-633-4198
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36988Medicare UPIN