Healthcare Provider Details

I. General information

NPI: 1477299659
Provider Name (Legal Business Name): FARYAL HAIDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST # 1700
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19648
SPRINGFIELD IL
62794-9648
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-9125
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036175719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: