Healthcare Provider Details

I. General information

NPI: 1801278650
Provider Name (Legal Business Name): FARID GHOLITABAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON ST STE 300
OAK PARK IL
60302-4210
US

IV. Provider business mailing address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-486-2700
  • Fax: 708-486-2702
Mailing address:
  • Phone: 708-216-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.148284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: