Provider Demographics
NPI:1538233424
Name:KHORSAND, JOUBIN (MD)
Entity type:Individual
Prefix:
First Name:JOUBIN
Middle Name:
Last Name:KHORSAND
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 1:8901 GOLF RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6850
Mailing Address - Country:US
Mailing Address - Phone:847-299-8844
Mailing Address - Fax:847-299-6420
Practice Address - Street 1:8901 GOLF RD
Practice Address - Street 2:SUITE 305
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6850
Practice Address - Country:US
Practice Address - Phone:847-299-8844
Practice Address - Fax:847-299-6420
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055404Medicaid
IL01617001OtherBLUE CROSS BLUE SHIELD
IL210567Medicare ID - Type Unspecified
IL036055404Medicaid