1053407486 NPI number — DR. FARID KARIMI M.D.

Table of content: DR. FARID KARIMI M.D. (NPI 1053407486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053407486 NPI number — DR. FARID KARIMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARIMI
Provider First Name:
FARID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1053407486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11235 DISTINCTIVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-479-5555
Provider Business Mailing Address Fax Number:
708-479-5055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11235 DISTINCTIVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-479-5555
Provider Business Practice Location Address Fax Number:
708-479-5055
Provider Enumeration Date:
10/05/2006

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: 2084P0800X , with the licence number:  036078525 , 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)

  • Identifier: 363791861 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: PVPB4797 . This is a "APS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 218330 . This is a "MHN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036078525 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363791861 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 67M18 . This is a "EMPIRE BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 31604099 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 056828 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DC2977 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110539 . This is a "COMPSYCH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363791861 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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