Provider Demographics
NPI:1073617536
Name:FARNE, JEAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:F
Last Name:FARNE
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 1:3724 VANTAGE LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1311
Mailing Address - Country:US
Mailing Address - Phone:773-463-2375
Mailing Address - Fax:773-463-2385
Practice Address - Street 1:4808 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5108
Practice Address - Country:US
Practice Address - Phone:773-463-2375
Practice Address - Fax:773-463-2385
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL487540Medicare ID - Type Unspecified
ILC38771Medicare UPIN