Active NPI
Keikhosrow Ghazanfari, MD
- Gastroenterology Physician
- Chicago, IL
National Provider Identifier
1831188747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 036047888
- Practice address
- 3004 N Ashland Ave
Chicago, IL 60657-3012 - Phone
- (773) 871-4600
- Fax
- (773) 871-2900
- NPI assigned
- Oct 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 036047888 | IL | Primary |
Addresses
Primary practice location
3004 N Ashland Ave
Chicago, IL 60657-3012
Mailing address
3004 N Ashland Ave
Chicago, IL 60657-3012
Phone (773) 871-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036047888 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036047888 | IL | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350000000000",
"number": "1831188747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3004 N ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606573012",
"telephone_number": "773-871-4600",
"fax_number": "773-871-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3004 N ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606573012",
"telephone_number": "773-871-4600",
"fax_number": "773-871-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHAZANFARI",
"first_name": "KEIKHOSROW",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-14",
"last_updated": "2012-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "IL",
"license": "036047888",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036047888",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.