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General NPI Number Information
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NPI Number | 1922785310
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Entity Type | Individual
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Provider Name | MAHMOUD FARHAT PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 4309 W MEDICAL CENTER DR STE A200
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City | MCHENRY
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State | IL
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Zip | 60050-8437
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Country | US
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Telephone | 815-759-8070
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Fax | 815-759-4931
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Provider Business Mailing Address
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Address Line | 4309 W MEDICAL CENTER DR STE A200
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City | MCHENRY
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State | IL
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Zip | 60050-8437
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Country | US
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Telephone | 815-759-8070
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Fax | 815-759-4931
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 5601011868
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085010446
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License Number State | IL
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