Provider Demographics
NPI:1841398963
Name:REZVAN, ABDOLMAJID T (MD)
Entity type:Individual
Prefix:DR
First Name:ABDOLMAJID
Middle Name:T
Last Name:REZVAN
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 1:1921 N HARLEM AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3740
Mailing Address - Country:US
Mailing Address - Phone:773-235-0800
Mailing Address - Fax:847-657-1622
Practice Address - Street 1:1921 N HARLEM AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3740
Practice Address - Country:US
Practice Address - Phone:773-235-0800
Practice Address - Fax:847-657-1622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12408Medicare UPIN
IL901420Medicare ID - Type UnspecifiedMEDICARE PROVIDER #