Provider Demographics
NPI:1235217381
Name:AGHA, FARIHA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIHA
Middle Name:
Last Name:AGHA
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 1:600 ENTERPRISE DR
Mailing Address - Street 2:STE 218
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4200
Mailing Address - Country:US
Mailing Address - Phone:630-620-0320
Mailing Address - Fax:630-620-0306
Practice Address - Street 1:600 ENTERPRISE DR
Practice Address - Street 2:STE 218
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4200
Practice Address - Country:US
Practice Address - Phone:630-620-0320
Practice Address - Fax:630-620-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH47148Medicare UPIN