Healthcare Provider Details

I. General information

NPI: 1417483090
Provider Name (Legal Business Name): OZAIR RAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

PO BOX 713160
CHICAGO IL
60677-0360
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-8000
  • Fax:
Mailing address:
  • Phone: 262-292-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036165724
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: