Provider Demographics
NPI:1992873624
Name:MAHDAVIAN, MANI (MD)
Entity type:Individual
Prefix:DR
First Name:MANI
Middle Name:
Last Name:MAHDAVIAN
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 1:150 N RIVER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1272
Mailing Address - Country:US
Mailing Address - Phone:847-290-3800
Mailing Address - Fax:847-290-0889
Practice Address - Street 1:150 N RIVER RD STE 210
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-290-3800
Practice Address - Fax:847-290-0889
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095201207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100016030OtherRAIL ROAD MEDICARE
IL036095201Medicaid
IL100016030OtherRAIL ROAD MEDICARE
IL036095201Medicaid