=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093810491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FARIBORZE B BARHAMAND MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 10/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SPALDING DR STE 110
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-369-1501
-----------------------------------------------------
Fax | 630-369-1560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1012 ANNE RD
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-567-0409
-----------------------------------------------------
Fax | 630-369-1560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 036-053994
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------