Provider Demographics
NPI:1457715435
Name:NEZAMI, BEHTASH GHAZI (MD)
Entity Type:Individual
Prefix:
First Name:BEHTASH
Middle Name:GHAZI
Last Name:NEZAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEHTASH
Other - Middle Name:
Other - Last Name:GHAZI NEZAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST STE 7-132I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-7913
Mailing Address - Fax:312-926-3127
Practice Address - Street 1:251 E HURON ST STE 7-132I
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-7913
Practice Address - Fax:312-926-3127
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036160562207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program