Provider Demographics
NPI:1306855481
Name:FALOUJI, FANAN MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:FANAN
Middle Name:MUSTAFA
Last Name:FALOUJI
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 1:92 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4868
Mailing Address - Country:US
Mailing Address - Phone:847-573-9006
Mailing Address - Fax:847-940-0843
Practice Address - Street 1:870 W END CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1383
Practice Address - Country:US
Practice Address - Phone:847-573-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
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
ILG83422Medicare UPIN
ILK35690Medicare ID - Type Unspecified