Healthcare Provider Details

I. General information

NPI: 1619908043
Provider Name (Legal Business Name): PEDRAM GERAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 1600
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8106
  • Fax: 312-695-0664
Mailing address:
  • Phone: 312-695-8106
  • Fax: 312-695-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036113197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: