Healthcare Provider Details

I. General information

NPI: 1952744732
Provider Name (Legal Business Name): NIDA FAHEEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEMORIAL DR STE 202
DECATUR IL
62526-1597
US

IV. Provider business mailing address

2 MEMORIAL DR STE 202
DECATUR IL
62526-1597
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-2780
  • Fax: 217-876-2785
Mailing address:
  • Phone: 217-876-2780
  • Fax: 217-876-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036166201
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number71314
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: