Healthcare Provider Details

I. General information

NPI: 1346401411
Provider Name (Legal Business Name): AMIR ALI BORHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-3737
  • Fax: 312-695-5645
Mailing address:
  • Phone: 312-695-3737
  • Fax: 312-695-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036.151431
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036151431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: