SHAHRIAR BOZORGZADEH (NPI# 1194726851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194726851 |
| Entity Type | Individual |
| Full Name | SHAHRIAR BOZORGZADEH |
| Credential | MD |
| Practice Address |
405 W Jackson St Carbondale IL 62901-1462 |
| Mailing Address |
Po Box 1467 Indianapolis IN 46206-1467 |
| Practice Telephone | 6185490721 |
| Practice Fax Number | 6184570469 |
| Mailing Telephone | 6184575200 |
| Mailing Fax Number | 6185290586 |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 036-096984 | IL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 36096984 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 0360096984 | 05 | |
| IL | BLUE SHIELD | 3932056 | 01 |
| IL | 036096984 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 201 S 14th St, Herrin, IL 629483631 | 6189422171 | 6189886186 |
| 2 S Hospital Dr, Murphysboro, IL 629663333 | 6186843156 | 6185290524 |
| Street Address |
405 W JACKSON ST |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568071132 | Cynthia Sue Davis | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-07-29 |
| 1629686019 | Dianne Zuasula Catolos | Physical Therapist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-07-21 |
| 1871113696 | Summer R Black | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-04-22 |
| 1871123067 | Hailee Elizabeth Bowlin | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-01-16 |
| 1972061737 | Briana Nichole Jones | Speech-Language Pathologist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2019-03-11 |
| 1700362183 | John Grady Johnston Jr. | Registered Nurse | 405 W Jackson St, Carbondale, IL 62901 | 2018-07-18 |
| 1972099067 | Andrew Mcnally | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-07-02 |
| 1134610587 | Megan E Sims | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-05-22 |
| 1447749833 | Erika Diericx | Pharmacist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-05-01 |
| 1609388545 | Rina Elizabeth Caslow | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901 | 2017-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710502570 | Zubin Wala | Family Medicine | 300 W Oak St Ste 200, Carbondale, IL 62901-1400 | 2020-06-08 |
| 1023490950 | Kowsika Movva | Family Medicine | 207 W Jackson St Ste 102, Carbondale, IL 62901-1408 | 2015-06-27 |
| 1710392428 | Andrew John Hossler | Family Medicine | 207 W Jackson St Ste 101, Carbondale, IL 62901-1408 | 2014-06-23 |
| 1487833091 | Sarah Hasek, Md, LLC | Family Medicine | 207 W Jackson St Ste 202, Carbondale, IL 62901-1408 | 2007-10-31 |
| 1770635062 | Deedra Gail Mclain | Family Medicine | 300 W Oak St, Carbondale, IL 62901-1400 | 2007-01-17 |
| 1710034236 | Anna Gabriela Konicek | Family Medicine | 151 Summit Dr, Carbondale, CO 81623-8747 | 2007-01-05 |
| 1295801835 | Kimball John Spence | Family Medicine | 1340 Hwy 133, Carbondale, CO 81623-1933 | 2006-11-27 |
| 1659447290 | Gary D Knaus | Family Medicine | 1340 Highway 133, Carbondale, CO 81623-1933 | 2006-11-27 |
| 1366526600 | Paul A Bennett | Family Medicine | 374 E. Grand Ave, Carbondale, IL 62901 | 2006-10-24 |
| 1285723635 | Roger D Jones | Family Medicine | 207 W Jackson Ste 102, Carbondale, IL 62901 | 2006-10-12 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.