Provider Demographics
NPI:1376912915
Name:HAYATGHAIB, FARHAD DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:DANIEL
Last Name:HAYATGHAIB
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 1:3001 GREEN BAY RD.
Mailing Address - Street 2:BLDG 133EF 3RD FLOOR - OUTPT MH CLINIC
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-3744
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD.
Practice Address - Street 2:BLDG 133EF 3RD FLOOR - OUTPT MH CLINIC
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250685492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry