Provider Demographics
NPI:1710285143
Name:ADDISON MEDICAL OFFICE, INC
Entity Type:Organization
Organization Name:ADDISON MEDICAL OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAREEDUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-828-3432
Mailing Address - Street 1:11 N ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3805
Mailing Address - Country:US
Mailing Address - Phone:630-833-5530
Mailing Address - Fax:630-833-5560
Practice Address - Street 1:11 N ADDISON RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3805
Practice Address - Country:US
Practice Address - Phone:630-833-5530
Practice Address - Fax:630-833-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty