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General NPI Number Information
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NPI Number | 1366083032
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Entity Type | Organization
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Legal Business Name | RAMIN GHAZIZADEH LLC
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 231 MAIN ST
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City | PARK FOREST
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State | IL
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Zip | 60466-2097
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Country | US
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Telephone | 708-748-3338
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Fax | 708-748-4332
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Provider Business Mailing Address
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Address Line | 231 MAIN ST
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City | PARK FOREST
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State | IL
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Zip | 60466-2097
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Country | US
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Telephone | 708-748-3338
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Fax | 708-748-4332
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RAMIN GHAZIZADEH
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Credential | DPM
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Telephone | 312-330-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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