Healthcare Provider Details

I. General information

NPI: 1609862135
Provider Name (Legal Business Name): B FLORIAN MIRANZADEH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 N ASHLAND AVE
CHICAGO IL
60613-4793
US

IV. Provider business mailing address

3718 N ASHLAND AVE
CHICAGO IL
60613-4793
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-9900
  • Fax: 773-327-0589
Mailing address:
  • Phone: 773-327-9900
  • Fax: 773-327-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036100398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: