Provider Demographics
NPI:1730395054
Name:PARVIN, MAHYAR (MD)
Entity type:Individual
Prefix:DR
First Name:MAHYAR
Middle Name:
Last Name:PARVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13400 S ROUTE 59 UNIT 116
Mailing Address - Street 2:BOX 245
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5830
Mailing Address - Country:US
Mailing Address - Phone:815-254-7400
Mailing Address - Fax:815-254-7408
Practice Address - Street 1:24821 W 135TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5413
Practice Address - Country:US
Practice Address - Phone:815-254-7400
Practice Address - Fax:815-254-7408
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361115922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111592 1Medicaid
IL036111592 1Medicaid