Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mariam Pestvenidze, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1427896679

Mariam Pestvenidze, MD is a Student in an Organized Health Care Education/Training Program in Evanston, Illinois. Licensed in Illinois. Registered with an NPI since 2024.

Licensed in
IL
In the registry since
2024
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

355 Ridge Ave
Evanston, IL 60202-3328
Phone: (847) 316-6228
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence 125.083823 (IL)

Record details

NPI number1427896679
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 19, 2024
Last updated in NPPESJuly 19, 2024
Certification dateJuly 19, 2024

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