Provider Demographics
NPI:1235519323
Name:FARES ALQARA INC
Entity Type:Organization
Organization Name:FARES ALQARA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALQARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-263-0469
Mailing Address - Street 1:4581 CHANDAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9138
Mailing Address - Country:US
Mailing Address - Phone:513-263-0469
Mailing Address - Fax:
Practice Address - Street 1:4581 CHANDAN WOODS DR
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61016-9138
Practice Address - Country:US
Practice Address - Phone:513-263-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty