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General NPI Number Information
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NPI Number | 1235519323
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Entity Type | Organization
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Legal Business Name | FARES ALQARA INC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 4581 CHANDAN WOODS DR
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City | CHERRY VALLEY
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State | IL
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Zip | 61016-9138
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Country | US
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Telephone | 513-263-0469
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Fax |
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Provider Business Mailing Address
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Address Line | 4581 CHANDAN WOODS DR
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City | CHERRY VALLEY
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State | IL
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Zip | 61016-9138
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Country | US
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Telephone | 513-263-0469
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARES ALQARA
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Credential | M.D.
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Telephone | 513-263-0469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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