Provider Demographics
NPI:1235766916
Name:FALLAHI, AMIRREZA (DO)
Entity type:Individual
Prefix:
First Name:AMIRREZA
Middle Name:
Last Name:FALLAHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 S KENNEDY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2682
Mailing Address - Country:US
Mailing Address - Phone:815-937-1237
Mailing Address - Fax:815-933-0662
Practice Address - Street 1:400 S KENNEDY DR STE 300
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-937-1237
Practice Address - Fax:815-933-0662
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361662752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry