Healthcare Provider Details

I. General information

NPI: 1588575773
Provider Name (Legal Business Name): FARZIN NAZIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N MILL RD APT 311B
ADDISON IL
60101-2453
US

IV. Provider business mailing address

235 N MILL RD APT 311B
ADDISON IL
60101-2453
US

V. Phone/Fax

Practice location:
  • Phone: 847-529-4201
  • Fax:
Mailing address:
  • Phone: 847-529-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.036577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: