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General NPI Number Information
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NPI Number | 1366646879
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Entity Type | Individual
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Provider Name | MOSTAFA ABDUL-RAHMAN FARACHE MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 305 W JACKSON ST STE 103
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City | CARBONDALE
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State | IL
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Zip | 62901-1474
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Country | US
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Telephone | 618-351-4972
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Fax | 618-351-6522
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Provider Business Mailing Address
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Address Line | 16513 HAVEN AVE
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City | ORLAND HILLS
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State | IL
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Zip | 60487-5637
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Country | US
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Telephone | 218-786-8364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036158130
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | W0804
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 50637
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2025024854
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License Number State | MO
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