Provider Demographics
NPI:1629176508
Name:FAKHRI, SABIHA HUSAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SABIHA
Middle Name:HUSAIN
Last Name:FAKHRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABIHA
Other - Middle Name:
Other - Last Name:SULTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3851 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3762
Mailing Address - Country:US
Mailing Address - Phone:765-464-2280
Mailing Address - Fax:765-464-2279
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3762
Practice Address - Country:US
Practice Address - Phone:765-464-2280
Practice Address - Fax:765-424-2279
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15648Medicare UPIN