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General NPI Number Information
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NPI Number | 1437648797
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Entity Type | Individual
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Provider Name | FAREHA MIR MD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1952 MCDOWELL RD SUITE 305
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City | NAPERVILLE
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State | IL
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Zip | 60563-6056
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Country | US
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Telephone | 630-689-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-6686
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Country | US
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Telephone | 773-702-1150
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2018009611
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036.156740
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License Number State | IL
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