Healthcare Provider Details

I. General information

NPI: 1932214152
Provider Name (Legal Business Name): SAMEER A ANSARI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

IV. Provider business mailing address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3185
  • Fax:
Mailing address:
  • Phone: 312-926-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036107893
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036107893
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036107893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: