Healthcare Provider Details

I. General information

NPI: 1194257840
Provider Name (Legal Business Name): NOEEN SARFRAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E SOUTHWIND RD
SPRINGFIELD IL
62703-5125
US

IV. Provider business mailing address

1501 KINGS HWY PSYCHIATRY
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 217-786-6930
  • Fax:
Mailing address:
  • Phone: 318-675-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336117065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: