Healthcare Provider Details

I. General information

NPI: 1437670718
Provider Name (Legal Business Name): ABDURRAHEEM FARRAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

2970 N SHERIDAN RD APT 916
CHICAGO IL
60657-5823
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 312-871-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125070273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: