Healthcare Provider Details

I. General information

NPI: 1134395825
Provider Name (Legal Business Name): MAHYAR PARVIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24821 W 135TH ST
PLAINFIELD IL
60544-5413
US

IV. Provider business mailing address

24821 W 135TH ST
PLAINFIELD IL
60544-5413
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-7400
  • Fax: 815-254-7408
Mailing address:
  • Phone: 815-254-7400
  • Fax: 815-254-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036111592
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036111592
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: DR. MAHYAR PARVIN
Title or Position: DIRECTOR OF CORPORATION
Credential: M.D.
Phone: 815-254-7400