Individual
FARHANA F UDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-5233
Mailing address
1031 CHESWICK DR, GURNEE, IL 60031-5601
(847) 708-8100
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085001218
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001619727
BCBS OF ILLINOIS
IL
01
—
212223
MEDICARE GROUP
IL
01
—
DE0395
RAILROAD MEDICARE GROUP
IL
Enumeration date
11/20/2007
Last updated
05/04/2021
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