Healthcare Provider Details

I. General information

NPI: 1710906847
Provider Name (Legal Business Name): FIRAS DAIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 W ALGONQUIN RD STE 104
ALGONQUIN IL
60102-9407
US

IV. Provider business mailing address

2971 W ALGONQUIN RD STE 104
ALGONQUIN IL
60102-9407
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-7693
  • Fax: 847-658-7986
Mailing address:
  • Phone: 847-658-7693
  • Fax: 847-658-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036091281
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036091281
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036091281
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
Identifier05632031
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS/SHIELD
# 3
Identifier290015175
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerRAIL ROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: