Healthcare Provider Details

I. General information

NPI: 1821859448
Provider Name (Legal Business Name): GARO GHAZARIAN MD, RRT-ACCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CLARK ST # 1051
CHICAGO IL
60640-2829
US

IV. Provider business mailing address

4000 W MONTROSE AVE # 905
CHICAGO IL
60641-2140
US

V. Phone/Fax

Practice location:
  • Phone: 781-698-8939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number194.011230
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number194.011230
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number194.011230
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: