MEDICARE: KOUROSH DINI MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036107898	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016 35637	OTHER	IL	BC/BSIL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184879256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOUROSH DINI MD LTD

Provider Business Mailing Address
First Line	:	1020 S WABASH AVE APT 4G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2255
Country	:	US
Telephone Number	:	312-391-3171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 S WABASH AVE APT 4G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2255
Country	:	US
Telephone Number	:	312-391-3171
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KOUROSH DINI
Credential	:	MD
Telephone Number	:	312-391-3171

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	12/03/2024

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