Healthcare Provider Details

I. General information

NPI: 1790893881
Provider Name (Legal Business Name): FARAH FAKOURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FARAH HASHEMI

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

IV. Provider business mailing address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

V. Phone/Fax

Practice location:
  • Phone: 773-918-4700
  • Fax: 773-313-3763
Mailing address:
  • Phone: 773-918-4700
  • Fax: 773-313-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number83655
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036089264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: