Provider Demographics
NPI:1689677148
Name:IRANI, MEHRABOON S (MD)
Entity type:Individual
Prefix:
First Name:MEHRABOON
Middle Name:S
Last Name:IRANI
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 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. PATHOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-570-2181
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPT. PATHOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14900207ZB0001X
AZ43214207ZB0001X
TXH2483207ZH0000X
IL036143963207ZP0102X, 207ZB0001X
NM9376207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5857Medicaid
NMP002122018Medicare PIN
NM5857Medicaid
NMNM301633Medicare PIN
NM345509502Medicare PIN
NMNM301632Medicare UPIN
NMNM302643Medicare PIN
NM347714502Medicare PIN
NMNM302627Medicare PIN
NMS003201034Medicare PIN