MEDICARE: FARHAD VOSSOUGHI 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	208600000X	Surgery Physician	036053514	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

General Provider Information

NPI Number	:	1194742924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHAD VOSSOUGHI MD

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-0967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 W 95TH ST
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	630-321-2710
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/16/2008

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