Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0116026700 | VA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036.142490 | IL |
NPI | 1063824027 |
---|---|
Provider Name | Dr. Ghazaleh Rostami Nia |
First Address | Evanston, IL 60201 |
Second Address | Evanston, IL 60201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 03/08/2017 |