Healthcare Provider Details

I. General information

NPI: 1255716320
Provider Name (Legal Business Name): FATIMA MUSTAFA KLASSMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA M. FAROOQI PA-C

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21481 N RAND RD
KILDEER IL
60047-3061
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-9696
  • Fax: 847-618-9695
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4759-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6082
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: