Provider Demographics
NPI:1114031382
Name:HOSAIN, FARZANA S (MD)
Entity Type:Individual
Prefix:
First Name:FARZANA
Middle Name:S
Last Name:HOSAIN
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 1:153 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-7010
Mailing Address - Country:US
Mailing Address - Phone:630-995-6635
Mailing Address - Fax:847-349-4267
Practice Address - Street 1:153 S STATE ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-7010
Practice Address - Country:US
Practice Address - Phone:847-683-3661
Practice Address - Fax:847-349-4267
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF84982Medicare UPIN