Healthcare Provider Details

I. General information

NPI: 1790897049
Provider Name (Legal Business Name): ASIF SERAJIAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W BUTTERFIELD RD STE 3A
ELMHURST IL
60126-5043
US

IV. Provider business mailing address

340 W BUTTERFIELD RD STE 3A
ELMHURST IL
60126-5043
US

V. Phone/Fax

Practice location:
  • Phone: 630-869-0888
  • Fax: 630-834-1017
Mailing address:
  • Phone: 630-869-0888
  • Fax: 630-834-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036126138
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number5101016935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: