MEDICARE: M. IMANI & P. IMANI, M.D., S.C.

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	2084P0800X	Psychiatry Physician		IL

General Provider Information

NPI Number	:	1649353830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. IMANI & P. IMANI, M.D., S.C.

Provider Business Mailing Address
First Line	:	130 N GARLAND CT
Second Line	:	SUITE 2605
City	:	CHICAGO
State	:	IL
Zip	:	60602-4750
Country	:	US
Telephone Number	:	312-641-1156
Fax Number	:	773-751-2250

Provider Business Practice Location Address
First Line	:	2959 S. COTTAGE GROVE AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616
Country	:	US
Telephone Number	:	312-759-8200
Fax Number	:	773-751-2250

Authorized Official
Title or Position	:	OWNER
Name	:	DR. POURAN IMANI
Credential	:	M.D.
Telephone Number	:	312-641-1156

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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