Healthcare Provider Details

I. General information

NPI: 1851359939
Provider Name (Legal Business Name): FARZANA IQBAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR SUITE 202
BURR RIDGE IL
60527-0844
US

IV. Provider business mailing address

901 MCCLINTOCK DR SUITE 202
BURR RIDGE IL
60527-0844
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6432
  • Fax: 630-654-4253
Mailing address:
  • Phone: 888-220-6432
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036114027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: