Provider Demographics
NPI:1124086012
Name:KAYHAN, SHAHROKH N (MD)
Entity type:Individual
Prefix:
First Name:SHAHROKH
Middle Name:N
Last Name:KAYHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:555-555-5555
Mailing Address - Fax:555-555-5554
Practice Address - Street 1:20201 CRAWFORD AVE
Practice Address - Street 2:SUITE 1276
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1010
Practice Address - Country:US
Practice Address - Phone:555-555-5555
Practice Address - Fax:555-555-5554
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053401208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053401Medicaid
IL4673170001OtherDMERC GROUP
ILP00006288/CK6882OtherMEDICARE RAILROAD
ILP00006289/CK6883OtherMEDICARE RAILROAD
D13288Medicare UPIN
ILP00006289/CK6883OtherMEDICARE RAILROAD
D13288Medicare UPIN