MEDICARE: ANAHITA BAHRAMI DO

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	207Q00000X	Family Medicine Physician	036-165646	IL

General Provider Information

NPI Number	:	1972131704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAHITA BAHRAMI DO

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9318
Country	:	US
Telephone Number	:	773-377-9910
Fax Number	:	773-377-9941

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

Provider Enumeration Date	:	03/28/2020
Last Update Date	:	10/02/2023

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