MEDICARE: DR. GHOLAMALI AFSHANG MD

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	2085R0202X	Diagnostic Radiology Physician		IL
2	2085N0700X	Neuroradiology Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00365615	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01615363	OTHER	IL	BLUE CROSS GROUP

General Provider Information

NPI Number	:	1316925522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHOLAMALI AFSHANG MD

Provider Business Mailing Address
First Line	:	3249 OAK PARK AVE
Second Line	:	RADIOLOGY
City	:	BERWYN
State	:	IL
Zip	:	60402-3429
Country	:	US
Telephone Number	:	708-783-2696
Fax Number	:	708-783-3164

Provider Business Practice Location Address
First Line	:	3249 OAK PARK AVE
Second Line	:	METROPOLITAN ADVANCED RADIOLOGY
City	:	BERWYN
State	:	IL
Zip	:	60402-3429
Country	:	US
Telephone Number	:	708-783-2696
Fax Number	:	708-783-3164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	02/14/2008

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Directions to “ DR. GHOLAMALI AFSHANG MD” Practice Location

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