Provider Demographics
NPI:1548335680
Name:AHMADIAN, YAHYA SEYED (MD)
Entity type:Individual
Prefix:DR
First Name:YAHYA
Middle Name:SEYED
Last Name:AHMADIAN
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 1:1801 VOLLMER RD
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422
Mailing Address - Country:US
Mailing Address - Phone:708-799-2409
Mailing Address - Fax:708-799-3326
Practice Address - Street 1:17901 GOVERNORS HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-799-0960
Practice Address - Fax:708-799-3326
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21624098OtherBLUE CROSS
IL0360451281Medicaid
IL21624098OtherBLUE CROSS
C41844Medicare UPIN