Healthcare Provider Details

I. General information

NPI: 1578428769
Provider Name (Legal Business Name): AASIL SHAYAN AZIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE
EVANSTON IL
60202-3399
US

IV. Provider business mailing address

355 RIDGE AVE
EVANSTON IL
60202-3399
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-6228
  • Fax: 847-316-3307
Mailing address:
  • Phone: 847-316-6228
  • Fax: 847-316-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.086779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: