MEDICARE: SABRINA FANAPOUR DO

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	036132381	IL

General Provider Information

NPI Number	:	1386965051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA FANAPOUR DO

Provider Business Mailing Address
First Line	:	7503 W CERMAK RD
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1405
Country	:	US
Telephone Number	:	708-442-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	7503 W CERMAK RD
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1405
Country	:	US
Telephone Number	:	708-442-0333
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	03/16/2021

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Directions to “ SABRINA FANAPOUR DO” Practice Location

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