Provider Demographics
NPI:1275658973
Name:ADAMJI, FAKHRUDDIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:FAKHRUDDIN
Middle Name:M
Last Name:ADAMJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2511
Mailing Address - Country:US
Mailing Address - Phone:847-864-1975
Mailing Address - Fax:
Practice Address - Street 1:1634 W POLK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4352
Practice Address - Country:US
Practice Address - Phone:312-829-4224
Practice Address - Fax:312-829-3742
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
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
ILD16541Medicare UPIN