Provider Demographics
NPI:1699068767
Name:BAGHMANLI, ZIYA (MD)
Entity type:Individual
Prefix:MR
First Name:ZIYA
Middle Name:
Last Name:BAGHMANLI
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 1:325 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278
Mailing Address - Country:US
Mailing Address - Phone:618-282-3831
Mailing Address - Fax:618-282-5476
Practice Address - Street 1:325 SPRING STREET
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278
Practice Address - Country:US
Practice Address - Phone:618-282-3831
Practice Address - Fax:618-282-5476
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.142899208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program