Provider Demographics
NPI:1881748341
Name:SARRAFI, GHODRATOLLAH (MD)
Entity type:Individual
Prefix:MR
First Name:GHODRATOLLAH
Middle Name:
Last Name:SARRAFI
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 1:380 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2290
Mailing Address - Country:US
Mailing Address - Phone:847-296-6699
Mailing Address - Fax:847-296-7437
Practice Address - Street 1:380 E NORTHWEST HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2290
Practice Address - Country:US
Practice Address - Phone:847-296-6699
Practice Address - Fax:847-296-7437
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474840Medicare ID - Type Unspecified
C41920Medicare UPIN