Healthcare Provider Details

I. General information

NPI: 1861296063
Provider Name (Legal Business Name): RAMISA FARIHA ALAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YACKTMAN PAVILION 1675 DEMPSTER
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

1555 ELLINWOOD AVE APT 520
DES PLAINES IL
60016-4599
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax:
Mailing address:
  • Phone: 602-513-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.086612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: