Healthcare Provider Details

I. General information

NPI: 1417584194
Provider Name (Legal Business Name): FARAH HAMADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 PRESCOTT AVE
LYONS IL
60534-1932
US

IV. Provider business mailing address

10S667 GLENN DR
BURR RIDGE IL
60527-6837
US

V. Phone/Fax

Practice location:
  • Phone: 872-282-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036169004
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036169004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: