Healthcare Provider Details

I. General information

NPI: 1104104959
Provider Name (Legal Business Name): SAFA RAHMANI M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

225 E CHICAGO AVE # 70
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6868
  • Fax:
Mailing address:
  • Phone: 312-227-6180
  • Fax: 312-227-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125059144
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036144972
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036144972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: