Bahram Ghaderi, MD, FACS

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036096824 Issued in IL

Practice address

2900 Foxfield Road
Suite 201
St. Charles, IL 60174

Phone

(630) 762-9697

Fax

(630) 762-9721

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1952497752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD ROAD",
            "address_2": "SUITE 201",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-762-9697",
            "fax_number": "630-762-9721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD ROAD",
            "address_2": "SUITE 201",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-762-9697",
            "fax_number": "630-762-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHADERI",
        "first_name": "BAHRAM",
        "name_prefix": "Dr.",
        "credential": "MD, FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036096824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096824",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL",
            "identifier": "04527510",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruth George
• Sophia George, LPC
• Georgina Srinivas Rao, M.D., S.C.
• Parisa Gerami-Lehnerer, M.D.
• Wendy Ann Getchius
• Salik Ghaus, PSY.D.
• Anthony P Giamberdino, MD
• Catherine Gillen
• Morgan Gilly
• Emmanuel Giovanis, D.C.

• Plastic Surgery Physician in St. Charles, IL
• Providers in St. Charles, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.