Provider Demographics
NPI:1487034195
Name:ALI, FARAHNAZ AMINA (DO)
Entity Type:Individual
Prefix:
First Name:FARAHNAZ
Middle Name:AMINA
Last Name:ALI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3860
Mailing Address - Country:US
Mailing Address - Phone:630-856-8900
Mailing Address - Fax:630-856-8933
Practice Address - Street 1:135 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-856-8900
Practice Address - Fax:630-856-8933
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067111390200000X
IL036144093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program