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General NPI Number Information
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NPI Number | 1063450757
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Entity Type | Individual
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Provider Name | PEYMAN PAHLAVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 153 1/2 N. BROADWAY AVENUE
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-345-8960
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Fax | 708-345-8965
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Provider Business Mailing Address
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Address Line | 153 1/2 BROADWAY AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 312-371-9325
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Fax | 708-345-8965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036-103944
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036103944
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License Number State | IL
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