Healthcare Provider Details

I. General information

NPI: 1841729084
Provider Name (Legal Business Name): SHAYAN ALAMGIR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 11/27/2023
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MONTGOMERY RD STE 108
AURORA IL
60504-9049
US

IV. Provider business mailing address

17101 ARBOR CREEK DR
PLAINFIELD IL
60586-5478
US

V. Phone/Fax

Practice location:
  • Phone: 630-923-9685
  • Fax: 630-401-8648
Mailing address:
  • Phone: 630-923-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005881
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: