Koosha Medical Center P C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0360856071 Issued in IL

Legal business name

KOOSHA MEDICAL CENTER P C

Practice address

4438 N Milwaukee Ave
Chicago, IL 60630-3743

Phone

(773) 794-2100

NPI assigned

Apr 5, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ebrahim Ghodsizadeh, M.D.

Title

Owner

Phone

(773) 794-2100

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1164711644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303743",
            "telephone_number": "773-794-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4438 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303743",
            "telephone_number": "773-794-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOSHA MEDICAL CENTER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GHODSIZADEH",
        "authorized_official_first_name": "EBRAHIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-794-2100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "0360856071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360856071",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanna Marie Kooistra, M.S., BCBA
• Melissa Koontz
• Rory Koontz, LPC
• Aita Koopahi
• Steven George Koopman, M.D.
• Melika Kooshki Forooshani, MD, MS
• Kooth USA LLC
• Anna K Kopchak
• Jason Kopec, MD
• Kelly Kopec, PHARM.D.

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.