Organization
FAMILY MEDICINE OF ILLINOIS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYEDA AISHA IFTIKHAR M.D. (PHYSICIAN)
(224) 567-8371
Entity
Organization
Contact information
Practice address
1507 S FALCON DR, LIBERTYVILLE, IL 60048-4897
(847) 494-0265
Mailing address
1507 S FALCON DR, LIBERTYVILLE, IL 60048-4897
(847) 494-0265
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036102332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102332
—
IL
01
—
1770599938
NPI INDIVIDUAL NUMBER
NE
01
—
207R00000X
TAXONOMY SPECIALITY CODE
—
Enumeration date
05/06/2008
Last updated
02/03/2021
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