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NPI Code Detail

MEDICARE: NEJAT DESTANI M.D.

MEDICARE: NEJAT DESTANI M.D.
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
1207Q00000XFamily Medicine Physician036086642IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295738771
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEJAT DESTANI M.D.
Provider Business Mailing Address
First Line : 6840 WINDSOR AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-3441
Country : US
Telephone Number : 708-484-0042
Fax Number : 708-749-5489
Provider Business Practice Location Address
First Line : 6840 WINDSOR AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-3441
Country : US
Telephone Number : 708-484-0042
Fax Number : 708-749-5489
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/09/2011

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