MEDICARE: A REZVAN MD SC AND ASSOCIATES

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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1578639498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A REZVAN MD SC AND ASSOCIATES

Provider Business Mailing Address
First Line	:	1921 N HARLEM AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60707-3740
Country	:	US
Telephone Number	:	773-235-0800
Fax Number	:	847-657-1622

Provider Business Practice Location Address
First Line	:	1921 N HARLEM AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60707-3740
Country	:	US
Telephone Number	:	773-235-0800
Fax Number	:	847-657-1622

Authorized Official
Title or Position	:	M.D.
Name	:	DR. ABDOLMAJID T REZVAN
Credential	:	M.D.
Telephone Number	:	773-235-0800

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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