MEDICARE: MR. MISBA FAROOQI PA-C

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	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1538815030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MISBA FAROOQI PA-C

Provider Business Mailing Address
First Line	:	222 HOLLY AVE
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-3963
Country	:	US
Telephone Number	:	630-570-1029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	708-422-6200
Fax Number	:

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

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	12/03/2025

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