Healthcare Provider Details

I. General information

NPI: 1366453839
Provider Name (Legal Business Name): FARAH TURK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 S RTE 30 SUITE 100
PLAINFIELD IL
60544-5686
US

IV. Provider business mailing address

13550 S RTE 30 SUITE 100
PLAINFIELD IL
60544-5686
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-1655
  • Fax: 815-436-1656
Mailing address:
  • Phone: 815-436-1655
  • Fax: 815-436-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036099659
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier215943
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE
# 2
Identifier036099659
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 3
Identifier9932640
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: