MEDICARE: DR. FARKHUNDA MAZHARUDDIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036065434	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31601508	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1023181088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARKHUNDA MAZHARUDDIN MD

Provider Business Mailing Address
First Line	:	2321 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2003
Country	:	US
Telephone Number	:	773-465-3500
Fax Number	:	844-364-6372

Provider Business Practice Location Address
First Line	:	2321 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2003
Country	:	US
Telephone Number	:	773-465-3500
Fax Number	:	844-364-6372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	08/15/2024

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