1629035670 NPI number — DR. FARIHA KAUSAR MD

Table of content: DR. FARIHA KAUSAR MD (NPI 1629035670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629035670 NPI number — DR. FARIHA KAUSAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUSAR
Provider First Name:
FARIHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629035670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12251 S 80TH AVE
Provider Second Line Business Mailing Address:
SUITE 1630
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-923-5173
Provider Business Mailing Address Fax Number:
708-923-5018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15300 WEST AVE
Provider Second Line Business Practice Location Address:
SUITE 225 SOUTH
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-226-2810
Provider Business Practice Location Address Fax Number:
708-226-2811
Provider Enumeration Date:
04/26/2006

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: 207RR0500X , with the licence number:  036125268 , 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: 036125268 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: F400269197 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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