Healthcare Provider Details

I. General information

NPI: 1760462246
Provider Name (Legal Business Name): RAZAN MASSARANI-WAFAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

5901 GARFIELD AVE
BURR RIDGE IL
60527-5234
US

V. Phone/Fax

Practice location:
  • Phone: 708-327-2618
  • Fax:
Mailing address:
  • Phone: 708-288-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number36089781
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036089781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: