Provider Demographics
NPI:1376275719
Name:MASTER, FAIZAN ASHARAF BHAI (MD)
Entity Type:Individual
Prefix:
First Name:FAIZAN
Middle Name:ASHARAF BHAI
Last Name:MASTER
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 1:4604 W 115TH PL # 8-213
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2214
Mailing Address - Country:US
Mailing Address - Phone:682-352-6317
Mailing Address - Fax:
Practice Address - Street 1:1625 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3603
Practice Address - Country:US
Practice Address - Phone:773-947-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125081015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine