Individual
FARAH FAKOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2734 W 87TH ST, CHICAGO, IL 60652-3937
(773) 918-4700
(773) 313-3763
Mailing address
2734 W 87TH ST, CHICAGO, IL 60652-3937
(773) 918-4700
(773) 313-3763
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036089264
IL
207RI0200X
Infectious Disease Physician
83655
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089264
—
IL
05
—
1790893881
—
WI
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
K53368
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P00708155
RR MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
08/28/2006
Last updated
05/12/2025
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