Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 28079 | AL |
Y | 207YS0123X | Facial Plastic Surgeon | 036116362 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 28079 | AL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036116362 | IL |
NPI | 1326233081 |
---|---|
Provider Name | Dr. Mobeen A Shirazi |
First Address | Woodstock, IL 60098-6911 |
Second Address | Woodstock, IL 60098-6911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116362 | (05) | IL |