Provider Demographics
NPI:1790184513
Name:NASSERI, EIMAN (MD)
Entity type:Individual
Prefix:MR
First Name:EIMAN
Middle Name:
Last Name:NASSERI
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 1:808 SOUTH WOOD STREET CARE OF HAYLE H. EVANS - DIRECTOR
Mailing Address - Street 2:ROOM 380 CME DEPARTMENT OF DERMATOLOGY (MC624) UNIVERSI
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-6966
Mailing Address - Fax:312-996-1188
Practice Address - Street 1:1740 WEST TAYLOR STREET
Practice Address - Street 2:THE UNIVERSITY OF ILLINOIS MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136678207ND0101X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology