Healthcare Provider Details

I. General information

NPI: 1760429609
Provider Name (Legal Business Name): BROADWAY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 1/2 N BROADWAY AVE
MELROSE PARK IL
60160-3702
US

IV. Provider business mailing address

153 1/2 BROADWAY ST
MELROSE PARK IL
60160-3702
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-8960
  • Fax: 708-345-8965
Mailing address:
  • Phone: 708-345-8960
  • Fax: 708-345-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEYMAN PAHLAVAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-371-9325