Healthcare Provider Details

I. General information

NPI: 1497301832
Provider Name (Legal Business Name): JABEEN FATIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E LAKE ST STE 102
ADDISON IL
60101-2873
US

IV. Provider business mailing address

1000 E 15TH ST
LOMBARD IL
60148-4701
US

V. Phone/Fax

Practice location:
  • Phone: 630-782-9780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036171801
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036171801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: