Provider Demographics
NPI:1669666236
Name:GHANI, NISHATH FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHATH
Middle Name:FATIMA
Last Name:GHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 SENATE DR APT 1G
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4930
Mailing Address - Country:US
Mailing Address - Phone:847-636-6693
Mailing Address - Fax:
Practice Address - Street 1:9116 SENATE DR APT 1G
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4930
Practice Address - Country:US
Practice Address - Phone:847-636-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-119001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0027340080OtherBCBS FMC GROUP #
IL803540OtherMEDICARE