MEDICARE: DR. ALAN P. NAZERIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036092890	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300110733	OTHER	IL	RR MEDICARE ID
5	P00312639	OTHER	IL	RR MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	612742700	OTHER	IL	DEPT. OF LABOR
2	1636444	OTHER		BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	130771300	OTHER	IL	DEPT. OF LABOR
7	2215114	OTHER		BCBS

General Provider Information

NPI Number	:	1235179409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN P. NAZERIAN M.D.

Provider Business Mailing Address
First Line	:	2000 SPRING RD
Second Line	:	SUITE 200
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-472-8800
Fax Number	:	630-472-9502

Provider Business Practice Location Address
First Line	:	2000 SPRING RD
Second Line	:	SUITE 200
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-472-8800
Fax Number	:	630-472-9502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/23/2007

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Directions to “ DR. ALAN P. NAZERIAN M.D.” Practice Location

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