Provider Demographics
NPI:1083321202
Name:FAHAD, SAFIA (MD)
Entity Type:Individual
Prefix:
First Name:SAFIA
Middle Name:
Last Name:FAHAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAFIA
Other - Middle Name:
Other - Last Name:ZAHEERUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4564 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1374
Mailing Address - Country:US
Mailing Address - Phone:847-630-1883
Mailing Address - Fax:
Practice Address - Street 1:2740 W FOSTER AVE STE 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3547
Practice Address - Country:US
Practice Address - Phone:773-784-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCOVIDIMG1812207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology