Provider Demographics
NPI:1316234446
Name:NIKNAM -BIENIA, SOLMAZ (MD)
Entity type:Individual
Prefix:
First Name:SOLMAZ
Middle Name:
Last Name:NIKNAM -BIENIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOLMAZ
Other - Middle Name:NIKNAM
Other - Last Name:LEILABADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:201 E OGDEN AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3658
Mailing Address - Country:US
Mailing Address - Phone:630-686-7255
Mailing Address - Fax:
Practice Address - Street 1:201 E OGDEN AVE STE 114
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3658
Practice Address - Country:US
Practice Address - Phone:630-686-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35142752208200000X
IL036.161394208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450441Medicaid