Healthcare Provider Details

I. General information

NPI: 1306855481
Provider Name (Legal Business Name): FANAN MUSTAFA FALOUJI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 N MILWAUKEE AVE STE 108
NILES IL
60714-2836
US

IV. Provider business mailing address

92 RIVERSIDE DR
DEERFIELD IL
60015-4868
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-4986
  • Fax:
Mailing address:
  • Phone: 847-903-4986
  • Fax: 847-940-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-096519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: