Provider Demographics
NPI:1437504768
Name:FAROOQ, ZAID (DO)
Entity Type:Individual
Prefix:
First Name:ZAID
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 GATEWAY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 GATEWAY DR STE 203
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-766-3942
Practice Address - Fax:815-758-5482
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036166716208800000X
IN02006403A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300051391Medicaid
IN000001552673OtherANTHEM
IN000001552582OtherANTHEM
IN000001552797OtherANTHEM