Provider Demographics
NPI:1194901470
Name:GOLZAR, YASMEEN AHMAD (MD)
Entity type:Individual
Prefix:MS
First Name:YASMEEN
Middle Name:AHMAD
Last Name:GOLZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:RM 3620
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-3034
Mailing Address - Fax:312-864-5068
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:RM 3620
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3034
Practice Address - Fax:312-864-5068
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120848207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120848Medicaid
IL347711Medicare PIN
347710Medicare PIN
IL036120848Medicaid