MEDICARE: DR. MOHAMMAD FAYYAZ MD

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
1	207RG0100X	Gastroenterology Physician	2044462-1	NY
2	207RG0100X	Gastroenterology Physician	036.172365	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161000580	OTHER	NY	EMPIRE
2	00010053906	OTHER	NY	UNIVERA
3	000524018005	OTHER	NY	HEALTH NOW
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0407905	OTHER	NY	INDEPENDENT HEALTH
6	061127000096	OTHER	NY	FIDELIS

General Provider Information

NPI Number	:	1992731616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD FAYYAZ MD

Provider Business Mailing Address
First Line	:	425 ESSJAY RD STE 170
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8235
Country	:	US
Telephone Number	:	716-630-1219
Fax Number	:	716-817-1726

Provider Business Practice Location Address
First Line	:	1009 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3747
Country	:	US
Telephone Number	:	312-996-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/28/2024

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