Provider Demographics
NPI:1649224122
Name:MERCHANT, FATEMA (MD)
Entity Type:Individual
Prefix:
First Name:FATEMA
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FATEMA
Other - Middle Name:
Other - Last Name:AZAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-503-2810
Mailing Address - Fax:312-503-5388
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-503-2810
Practice Address - Fax:312-503-5388
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77230Medicare UPIN