Healthcare Provider Details

I. General information

NPI: 1235471327
Provider Name (Legal Business Name): FARAH M CHAUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BALLARD RD
PARK RIDGE IL
60068-1005
US

IV. Provider business mailing address

1775 BALLARD RD
PARK RIDGE IL
60068-1005
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-6020
  • Fax:
Mailing address:
  • Phone: 847-318-6020
  • Fax: 847-318-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.138999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: