Healthcare Provider Details

I. General information

NPI: 1255028452
Provider Name (Legal Business Name): FARWAH YAWAR ALI SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FARWAH RIZWAN MD

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2315
US

IV. Provider business mailing address

2856 FINCA TER
FREMONT CA
94539-4474
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2000
  • Fax: 312-638-8320
Mailing address:
  • Phone: 650-279-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: