Provider Demographics
NPI:1023181088
Name:MAZHARUDDIN, FARKHUNDA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARKHUNDA
Middle Name:
Last Name:MAZHARUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 W CHICAGO AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5512
Mailing Address - Country:US
Mailing Address - Phone:773-278-8727
Mailing Address - Fax:844-364-6372
Practice Address - Street 1:1802 W CHICAGO AVE STE 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5512
Practice Address - Country:US
Practice Address - Phone:773-278-8727
Practice Address - Fax:844-364-6372
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065434Medicaid
IL31601508OtherBCBS
IL036065434Medicaid