1285121228 NPI number — ANAM IFTIKHAR FAROOQUI

Table of content: ANAM IFTIKHAR FAROOQUI (NPI 1285121228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285121228 NPI number — ANAM IFTIKHAR FAROOQUI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAROOQUI
Provider First Name:
ANAM
Provider Middle Name:
IFTIKHAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285121228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 HARVESTER DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURR RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527-5965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-702-1150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5841 S MARYLAND AVE # MC6060
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60637-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-702-6210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  036156769 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)