=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780711408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA JAFRI QAZI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 E CHICAGO AVE BOX 152
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-936-4142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 ROCK RIVER CT
-----------------------------------------------------
City | ALGONQUIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60102-6836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-936-4142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101241073
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------