Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036-127466 | IL |
N | 207R00000X | Internist | 036-127466 | IL |
N | 111NI0900X | Internist | 036-127466 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036-127466 | IL |
NPI | 1659514131 |
---|---|
Provider Name | Mahboobeh Mahdavinia |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 27/04/2021 |