Healthcare Provider Details

I. General information

NPI: 1114031382
Provider Name (Legal Business Name): FARZANA S HOSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S STATE ST
HAMPSHIRE IL
60140-7010
US

IV. Provider business mailing address

153 S STATE ST
HAMPSHIRE IL
60140-7010
US

V. Phone/Fax

Practice location:
  • Phone: 847-683-3661
  • Fax: 847-349-4267
Mailing address:
  • Phone: 630-995-6635
  • Fax: 847-349-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-087911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: