Healthcare Provider Details

I. General information

NPI: 1366739013
Provider Name (Legal Business Name): SADAF FAROOQI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W COURT ST
KANKAKEE IL
60901-3661
US

IV. Provider business mailing address

500 W COURT ST
KANKAKEE IL
60901-3661
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7748
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036135092
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: