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NPI Code Detail

MEDICARE: GHAZALA FAYYAZ M.D.

MEDICARE: GHAZALA FAYYAZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician036113634IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11669563789OTHERILBLUE CROSS BLUE SHIELD OF IL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649223595
Entity Type Code : Individual
Provider Name (Legal Business Name) : GHAZALA FAYYAZ M.D.
Provider Business Mailing Address
First Line : 1542 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1344
Country : US
Telephone Number : 773-465-4600
Fax Number : 734-465-4666
Provider Business Practice Location Address
First Line : 1542 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1344
Country : US
Telephone Number : 773-465-4600
Fax Number : 773-465-4666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/11/2022

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