MEDICARE: DR. GHASEM YAZDANPANAH MD, MPH, PHD

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	207W00000X	Ophthalmology Physician	125.080296	IL
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	35.154721	OH

General Provider Information

NPI Number	:	1467192435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHASEM YAZDANPANAH MD, MPH, PHD

Provider Business Mailing Address
First Line	:	820 S WOOD ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S WOOD ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-2933
Fax Number	:

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

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	02/13/2026

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