Provider Demographics
NPI:1497013262
Name:RAFIDI, FADIA AMJAD
Entity Type:Individual
Prefix:MRS
First Name:FADIA
Middle Name:AMJAD
Last Name:RAFIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N LAKE SHORE DR
Mailing Address - Street 2:UNIT 1005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3427
Mailing Address - Country:US
Mailing Address - Phone:224-567-2223
Mailing Address - Fax:312-277-0923
Practice Address - Street 1:505 N LAKE SHORE DR
Practice Address - Street 2:UNIT 1005
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3427
Practice Address - Country:US
Practice Address - Phone:224-567-2223
Practice Address - Fax:312-277-0923
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter