Healthcare Provider Details

I. General information

NPI: 1659785236
Provider Name (Legal Business Name): IMRAN URAIZEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST RM 1155M
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST RM 1155M
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5631
  • Fax: 708-684-5709
Mailing address:
  • Phone: 708-684-5631
  • Fax: 708-684-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125.064485
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036145625
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: