Provider Demographics
NPI:1619950060
Name:KUREISHY, FARRUKH A (MD)
Entity Type:Individual
Prefix:
First Name:FARRUKH
Middle Name:A
Last Name:KUREISHY
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 1:422 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2272
Mailing Address - Country:US
Mailing Address - Phone:217-935-9571
Mailing Address - Fax:217-935-7603
Practice Address - Street 1:422 W WHITE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2272
Practice Address - Country:US
Practice Address - Phone:217-935-9571
Practice Address - Fax:217-935-7603
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101594Medicaid
601024200OtherUS DEPT OF LABOR
IL02032003OtherBLUE CROSS BLUE SHIELD
101594OtherOSF HEALTHPLANS
450314OtherHEALTHLINK
056153OtherHEALTH ALLIANCE
2191466OtherUNITED HEALTHCARE
7732279OtherAETNA
ILF86046Medicare UPIN
2191466OtherUNITED HEALTHCARE
ILIL5546001Medicare PIN
601024200OtherUS DEPT OF LABOR
450314OtherHEALTHLINK